Home :: Online Order Form

Online Order Form


MAIL-IN, E-MAIL, FAX ORDER FORM

I have read, understood and I accept the Terms and Conditions and I wish to order the following items:
Please print it out. Type or print clearly. Email to: Please do NOT post our email address in its text format on the web!

IMPORTANT: incompletely filled out orders will be delayed for clarification.



Code#       Country              Description                Grade    Unit        Price     Qty        Total in €
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NOTE: Attach your order on a separate sheet if necessary. Sign every sheet.
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SUBTOTAL: ________________

POSTAGE & HANDLING (delivery by__________________________mail): ____________

Your UPS Account # (if you pay your own shipping):__________________________

Your FedEx Account # (if you pay your own shipping):__________________________

TOTAL: ________________



I am paying with/via: ( ) PAYPAL** ( ) CHECK ( ) MONEY ORDER ( ) CASH
( ) BANK WIRE TRANSFER ( ) BANK DRAFT ( ) WESTERN UNION ( ) CREDIT CARD
( ) OTHER _________________________________________________________________


** We will send you a PAYPAL invoice or provide you with our Paypal specific email address  

Your Paypal email address: ___________________________________________________


Please charge my credit/debit card for my order# __________:

( ) VISA ( ) MC ( ) AMEX ( ) DISCOVER ( ) NOVUS ( ) OTHER .........

Name on Credit/Debit Card: ___________________________________________________

Billing Company (if any): ____________________________________________________

Card Number*: [______________________________________________________________]


* American Express # is 15 digit, Visa 13 or 16 digit, MC & Discover 16 digit.

CVV/CVC/CIN # (3/4 digits on the back/front of your card): [_________________]

Customer Accounting Code (if corporate card): ________________________________

Card Expiration Date: [______/___________] (MM/YYYY)



Billing/Statement Address: ___________________________________________________

______________________________________________________________________________

City: ________________________________ Province/State: _______________________

Postal Code or Zip: _____________________ Country: ______________________________

DATE OF ORDER ________________________

PERSONAL/BUSINESS/SHIPPING INFORMATION (please type or print clearly)

Name: (Mr./Ms.)_______________________________________________________________

Business Name (if any): ______________________________________________________

Shipping Address: ____________________________________________________________

______________________________________________________________________________

City: _______________________________ Province/State: ________________________

Postal Code or Zip: ____________________ Country: _______________________________

( ) Check if the above address is a commercial location (for UPS or FEDEX delivery)
( ) Check if the above is a residential address (for UPS or FEDEX shipping)
( ) Check if the above address is a home-based business (for UPS or FEDEX delivery)

NOTE: please check only one selection above!

Phone number: ( )_______________________________________

Fax number: ( )_______________________________________

E-mail (print clearly): ____________________________________________________

Comments: ____________________________________________________________________

______________________________________________________________________________


Authorization Signature: _____________________________________________________


Online Order & Card Payment Form Nº006124