Master Card Interbank No.
Total
| ORDER FORM |
Champlin Net Co.
P. O. Box 788
Jonesville, LA 71343
Phone (318) 339-7959
P. O. Box 788
Jonesville, LA 71343
Phone (318) 339-7959
| (318) 339-7959 Fax: (318) 339-8485 Toll Free 1-877-339-8485 1-800-551-5183 or 1-877-526-7210 |
Sold To:_______________________________________________________Date:__________________
Address:_________________________________________________________Phone____________________
City:________________________________________State_____ Zip________________
Ship to:____________________________________Address________________________________________
City:________________________________________State_____Zip________________
___Payment Enclosed ____UPS
___C.O.D. ____Parcel Post ____Truck
Address:_________________________________________________________Phone____________________
City:________________________________________State_____ Zip________________
Ship to:____________________________________Address________________________________________
City:________________________________________State_____Zip________________
___Payment Enclosed ____UPS
___C.O.D. ____Parcel Post ____Truck
|
Est. Postage, Insurance, & Handling
4 % Sales Tax for Louisiana Residents
Total Amount of this Order
If you use your charge card, fill out boxes below
Credit Card Number
Expiration Date: Month/Year
| NO CREDIT! ALL SALES ARE CASH, PERSONAL CHECK, C.O.D., DISCOVER, VISA OR MASTERCARD 15% restocking charge on all returned merchandise after 30 days. Invoice must accompany all returns. |
| PRINT THIS FORM FOR MAIL OR PHONE ORDERS |
| THANK YOU FOR YOUR BUSINESS CALL US ANYTIME! |
