Bigeyes - purchase order

 


To purchase please complete the following order form.

  • A major credit card number is required..
  • If you would rather not send your credit card number through Cyber Space leave the field blank and we will secure it over the telephone.
  • Payments will be processed at time shipping.
  • We except Visa, MC, AMEX.

  TAB to move between fields. *required feilds
   

 

Billing Address:

Name:

*

Address: 

*

City: 

*

Province/State: 

*

Country: 

*

Postal / Zip Code: 

*

E-mail: 

*

Phone: 

*

Fax: 

 

 
   

 

 

Credit Card:

Visa Mastercard American Express

Card Number:

Expiry Date:

This card belongs to:

   

 Special Comments - If shipping address is different than billing address please fill in here

Confirm by:

   

 



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