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IPexpert, Inc.
Product Order Form
For prompt processing of your order, please observe these pointers:
1. Be sure to provide all information requested on this form.
2. Please print all information clearly.
Your Name:
_________________________________________________
Date of Purchase: _________________________________________________
Please list the product(s) you wish to order here:
__________________________________________________
__________________________________________________
__________________________________________________
Subtotal from above:
Price of Product:
_____________
_____________
_____________
_____________
Add shipping / handling: $25.00 $55.00
USA International
Total purchase amount: _____________
Credit Card number:
Expiration Date:
Name exactly as it appears on card:
_____________________________________________
_____________________________________________
_____________________________________________
Billing address for this credit card: Address 1: ________________________________
Address 2:
________________________________
City, State, Zip: ________________________________
Telephone Number:
Email Address:
_____________________________________________
_____________________________________________
Shipping Address: Address 1: ________________________________
(If different than Billing Address)
Address 2: ________________________________
City, State, Zip: ________________________________
Signature: _____________________________________
Date: _______________
FAX THIS FORM TO +1.810.454.0130
IPexpert, Inc. | Product Order Form