The Checkmate Group, 0-0-0Checkmate,. BrightWorld and 24Hours7Days
1703 Highway 93 North, Scott, LA 70583
Fax:(413)691-8722
Date:___________________
YOUR SHIPPING INFORMATION YOUR BILLING INFORMATION
Name:__________________________________ Name:__________________________________ Shipping Address:___________________________ Billing Address:_________________________ _______________________________________ _______________________________________ City:_______________________ City:_______________________ State:_____________ Zip:____________ State:_____________ Zip:____________ Country___________________ Country___________________ Phone:____________________________ (Required)* Your Email:________________________ (Required)*
Item No# Description Quantity Price Per Unit Total Price Faxed orders received after 2pm CST will be processed on the next business day. Mail In Only, Make Payment to: The Checkmate Group. Order will ship after check clears banking systems. Money orders ship upon receipt. International must supply US Bank Draft for total in US Dollars only.
Sub-Total Shipping (See Below) Total
| Card
Number:_________________________________________________EXP:________
3-4 Digit Security Code _______ (required!*) Visa, MC, Disc: Last 3 digits on back of card in signature line. AMEX (only) can also be located on front of card 4 digits for older verions of the card. |
|
Clear Signature:_______________________________________________________________ Print Exact Billing Name___________________________________________________ |
| Check Number:___________ |
Shipping rates as follows:
| Regular Shipping | 7-10 Business Days | $7.95 | No Item Limit |
| Rush Shipping | 3-4 Business Days | $17.95 | No Item Limit |
| International, Military, HI, AK | Quote Only | Contact Customer Service | Contact Customer Service |
*Please see information on our order requirements with respect to our outstanding privacy policy.