DIGITAL-DOC IMAGING ORDER FORM

Allow 2 weeks delivery on some orders

Order Information:		Credit Card Order Form:
		ITEM #	NAME/DESCRIPTION	PRICE	QTY.		TOTAL
Send Form Via Mail To: DIGITAL-DOC IMAGING 332 NE 5th St. Grand Prairie, TX 75050 USA email Tom for your order Shipping Information: Add $5 S/H for U.S. orders, $7.50 for Canada. For International shipping, please designate surface or air: Charges will be added. If you want your order insured add: $0--$50....$.75 $100....$1.60  $200....$2.50 $300....$3.40 US orders only. For International orders insured: Charges will be added. Not responsible for lost or damaged orders without insurance.
					Subtotal
					S/h
					Insurance
				Texas Resident's Tax
					Total
Terms and Conditions:  Checks or Money Orders must be drawn on US banks. VISA, MasterCard, Discover, welcome. International orders accepted-- preferably on credit cards.		Ship To:
		Name
		Customer Number	(Not required)
		Address 1
		Address 2
		City		State
		Country		Zip
		Email
		Day phone
		Home phone
		CHARGE ORDERS CANNOT BE PROCESSED WITHOUT THE FOLLOWING:
		Billing Address:
			Check here if Shipping/Billing address are the same
		Name
		Address 1
		Address 2
		City		State
		Country		Zip
		Email
		Day Phone
		Billing Information:
		Credit Card Type	MASTERCARD VISA DISCOVER
		Cardholder Name
		Card Number
00/00		Expiration Date