6
VISA
MC
DISCOVER
AM EX
CHECK
MONEY ORDER
Ship to Name (Please print clearly)
Address
City
State
Zip Code
Phone #
Shipping address must be the same as billing address
SIGNATURE (required for credit card purchases)
CARD#
EXP
.
DATE
*CVV2 #
ORDER FORM
*CVV2 is an authentication process established by credit card companies to reduce fraud for internet transactions. It
consists of requiring a card holder to enter the CVV2 number in at transaction time to verify the card is on hand. For VISA, MASTERCARD, or
DISCOVER, the 3 digit number is found on the back of the card. This number is printed on the signature area (last 3 digits after the card number). For
AMERICAN EXPRESS cards, the 4 digit number is printed above to the right of the imprinted credit card number on the front of the card. Please call
T
elpro at 1.800.448.0822 if you have questions.
Copy this order form to place orders.
Phone# 1-800-448-0822 Fax# 1-800-474-9993
E-mail:
Quantity
Part#
Description
Price Each Total Price
Sub Total
Shipping
Total
MAIL ORDER TO:
ATTN: Sales Dept.
7251 South 42nd St. Grand Forks, ND 58201
www.paragonpromfg.com
