Print Order Form[1]
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Phone in Order Form Name_________________________________________________________________ Address_______________________________________________________________ City__________________________________State_____________Zip____________ Phone #_______________________________________________________________ E-mail_______________________________________________@________________ ORDER INFORMATION Item Qty
Title
Price
Total
Total Order__________ Tax__________________ Shipping/Handling___________ Amount Due___________
SHIPPING INFORMATION Name___________________________________________________________________ Street__________________________________________________________________ City______________________________State______________Zip_________________ Preferred Shipping Method: _ Delivery Conformation _ U.S. Mail CHECK/MONEY ORDER CUSTOMER Make Check or Money Order Payable To: Urban Heat Book Distribution *Certain Checks require 3-4 days clearance prior to Shipment Mail Form:
Urban Heat Book Distribution 199 Lincoln Avenue, Suite #209 Bronx, N.Y. 10454 CREDIT CARD CUSTOMER MasterCard Visa Debit America Express
Card #________________________________________________________________________________ Exp. Date___/______/____ 4 digit code________ Card Holders Name_____________________________________________________________________ Credit Card Billing Address______________________________________________________________ *Delivery within 1 week for Credit Card Orders
Fax this Form to 1(718)-292-9195 OFFICE USE ONLY Order Taken by_____________________ Date_________Time_____________ Order date: ____________Method: _ Delivery Conformation _ Signature Conformation _ Other
Title
Price
Total
Total Order__________ Tax__________________ Shipping/Handling___________ Amount Due___________
SHIPPING INFORMATION Name___________________________________________________________________ Street__________________________________________________________________ City______________________________State______________Zip_________________ Preferred Shipping Method: _ Delivery Conformation _ U.S. Mail CHECK/MONEY ORDER CUSTOMER Make Check or Money Order Payable To: Urban Heat Book Distribution *Certain Checks require 3-4 days clearance prior to Shipment Mail Form:
Urban Heat Book Distribution 199 Lincoln Avenue, Suite #209 Bronx, N.Y. 10454 CREDIT CARD CUSTOMER MasterCard Visa Debit America Express
Card #________________________________________________________________________________ Exp. Date___/______/____ 4 digit code________ Card Holders Name_____________________________________________________________________ Credit Card Billing Address______________________________________________________________ *Delivery within 1 week for Credit Card Orders
Fax this Form to 1(718)-292-9195 OFFICE USE ONLY Order Taken by_____________________ Date_________Time_____________ Order date: ____________Method: _ Delivery Conformation _ Signature Conformation _ Other
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