ALLAMERICANSTORES FAX FORM AND MAIL ORDER FORM
FAX 1- (800) 314-1541
Customer Name __________________________________________________________
Address ________________________________________________________________
City _____________________________ State __________________ Zip _________
Phone ____________________ E-Mail Address _______________________________
Credit Card BILLING ADDRESS if different than Shipping Address on Credit Card Orders only
______________________________________________________________________________
______________________________________________________________________________
your FAX Number (on FAX Orders) _____________________________________________
Payment: Credit Card_________ Check_____________ Money Order_____________
(Make check/money order payable to ALLAMERICANSTORES at address above)
Card # _________________________________________ Expiration Date __________
Card Type: VISA/ MC______________ 3 Digit Card Code on Back of Card _________
Name on Card ___________________________________________________________
Signature _______________________________________________________________
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SHIPPING COSTS ARE AS FOLLOWS: ($1 TO $50) = $6.75 -- ($51 TO $100) = $7.95 -- ($101 TO $175) = $9.95 --
($176 TO $250) = $14.95 -- ($251 TO $350) = $19.95 (Above $350 to $999) = $25
Shipping Address _______________________________________Subtotal __________
City _______________________ *For Kansas residents–add 7% Tax _________
State _________________________ Zip _______ Shipping __________
Total __________
