FAX ORDER FORM
Toll Free 1.866.829.6522
Fax Order Form
Please complete this form and fax to
972-398-3889
or
mail with company check to:
Perfect PD Ruler
P.O. Box 863838
Plano, TX 75086-3838
Name of Business:
Address:
Contact Information:
Contact Person:
Phone Number:
Email Address:
Pay by:
Select Payment Method
By Check
By Credit Card
Credit Card Payment:
Select Credit Card
Visa
MasterCard
American Express
Discover
Card Holder:
Number:
Expiration Date: (MM/YY)
CSC Code: (3 or 4 digit)
Billing Address:
Special Instructions:
Purchase:
Standard Rulers
0
Custom Rulers
0
Setup Fee
$0.00
Shipping & Handling
$0.00
Tax
(Only for Texas residents)
Total
$0.00
Transaction Authorized By:
Print Name:
Title:
Date:
©2005 Perfect PD Ruler – An
ADS Eyewear Company
