JordanAlmonds.com   

Copyright 2002-2008   JordanAlmonds.com

 The official resource for

Jordan Almonds

also visit:

HometownCandy.com

for

every Candy

 

 

 

---

 

                        Credit Card FAX or EMAIL Form

        To: JordanAlmonds.com

        FAX (215) 392-4340

        Email to:  info@JordanAlmonds.com by clicking on the "Submit" button at the bottom of this page.

        Please Check Applicable Statements:

        I have received an Order Quote email or I am listing my Order below and would like my order processed and my credit card charged now.

           I am emailing my credit card information by submitting this form via the SUBMIT button below, or I am FAXING this form to (215) 392-4340.

    Items and Quantities Ordered:

   

    Total Price of Order: $

    CREDIT CARD TYPE:   

      VISA        MASTERCARD      AMEX      DISCOVER

    CREDIT CARD NUMBER:   

     EXPIRATION DATE:   /   3 DIGIT CODE: 
  

    I am the cardholder of the card submitted in this form and I authorize my card to be charged for the Order Total.

    Signature ___________________________

    Cardholder Name 

    Billing Address: Street
                                City  
                                State
                                ZIP   

    Email:   @  .

    Phone : Area Code    Number -

    FAX :   Area Code    Number -

    Need by Date:     Event Date: 

    Please confirm my order via:

        Email

        FAX

    Comments:

   

      Kindly Press the "Submit" button to send us your email form             

                Copyright 2002-2008 JordanAlmonds.com