| PAYMENT INFORMATION - Checks payable to HappyBalls |
| Name: |
| Address: |
| City: |
State: |
Zip: |
| Phone: |
E-Mail: |
| Credit Card Number: |
Expiration Date: |
_____ / _____ / _____ / _____ |
_____ / _____ |
|
|
| PRODUCT INFORMATION |
| Description |
Qty.
|
Price
|
Total
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
SHIPPING INFORMATION
USPS - GROUND = $3.25
USPS - PRIORITY MAIL = $6.75
No matter how many balls you order, shipping is always one low rate! |
| SubTotal |
|
| Tax 7% - GA. Only |
|
| Shipping |
|
| Total |
|
|
| SHIPPING INFORMATION - (If Different from Payment info) |
| Name: |
| Address: |
| City: |
State: |
Zip Code: |
|
| SIGNATURE |
By signing this form you agree that (1) you are the credit card holder listed (2) that you are requesting the products listed above and (3) that you are authorizing this card to be charged by HappyBalls for the total of your purchase.
Signature: _______________________________ Date: __________________
|
|
Thank you for your business.
