The
Fair Price Shop Fax
Order Form
Print out this form and fax it to +1 419 (730)- 4382
Return to www.fairpriceshop.com
|
|
|
Credit Card Orders
TO: Fairpriceshop.com
ATTN: ___________________________________ (Sales Rep, Default : AMMAR)
8345 NW 66th ST # 6045
Miami, FL, 33166. USA
Please charge US$ ________ to
my MasterCard 
Visa
.
Customer Name:
___________________________________________ (As it appears on the Credit Card)
|
|
— |
|
— |
|
— |
|
(Print Card Number Legibly) |
Expiration Date: ____ /
________
C V V / C V V 2 : 
(3 digit code on back of card)
|
|
SHIPPING ADDRESS |
|
BILLING ADDRESS (if different) |
|
Name |
|
|
|
|
Address |
|
|
|
|
City, State Zip Code |
|
|
|
|
Country |
|
|
|
|
Daytime Phone Number |
|
|
|
|
|
|
|
|
|
|
Type of Purchase |
|
|
Laptop Model |
Size Screen |
Screen Part # |
|
|
|
|
By signing you are giving The Fair Price shop credit card authorization for the above purchase and acknowledge that you have read
and agree to be bound by our Terms & Conditions.
Your credit card charge for The Fair Price Shop will be reflected as "fairpriceshop.com" on your monthly statement.
Authorized Signature:
_______________________
Today's Date: _____________________________