CompuDirect Order by FAX
Complete this form and FAX to 678-302-5368.  Be sure you have read our Shipping and Return policies. 
BILLING INFORMATION:

__________________________________________________________________________
Company Name                                           

_________________________________   ________________________________   ___
Last Name                           First Name                         MI

__________________________________________________________________________
Street Address

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Street Address

________________________  ___________________________   __________________
City                      State                         Zip Code

________________________  _____   ________________________
Telephone number          Ext.    FAX telephone Number

__________________________________________________________________________
E-mail address (Yahoo, Hotmail, MSN, etc. will delay your order.)

Visa, Discover, MC,   ________-________-________-________  ____/______

(Circle one of the above) Credit Card Number               Month  Year

_________________________________  _______________________________________

Name as it appears on credit card  Name of credit card issuer (i.e. Bank)

Telephone number on back of card:  _________________________________

3 or 4 digit code appearing on back of card, next to signature:  _________

ORDER INFORMATION:

Please use the SKU/Item Number from our website.

I am purchasing the following items:

Qty __ of Item # _______________ Description: ____________________________

Qty __ of Item # _______________ Description: ____________________________

Qty __ of Item # _______________ Description: ____________________________

Qty __ of Item # _______________ Description: ____________________________

Qty __ of Item # _______________ Description: ____________________________

Qty __ of Item # _______________ Description: ____________________________

I would like my order shipped via: (__) Ground   (__) FedEx Overnight

Please Select One:

(__) I authorize the appropriate shipping charge to be added to my order. 

(__) E-mail me and wait for my approval of an estimated shipping charge.


Please ship my order to: (if different than billing info., no P.O. boxes):

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


I have read and agree to the terms of this sale as described in CompuDirect's
Shipping and Return Policies and authorize CompuDirect or its agent to charge 
the indicated credit card the sale amount of the items indicated above, 
plus shipping and handling.

X________________________________________________   ____ / ____ / ________

Signature                                          Month  Day    Year
Every effort has been made to ensure the accuracy of information displayed, however we are not responsible for typographical errors.

http://compudirect.net/

Questions?  Call us at 770-516-3591, Mon-Fri 9-5 EST.