Eyespyvideo.com
United States Fax Order Form
Print
and complete this form then fax to 800-568-6353 or 314-993-4803
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Company
Name
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Contact
Name
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PO#
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Phone
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Fax
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Email
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Billing
Address
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Shipping
Address
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Top of Form
Credit
Card Type:
Visa
MasterCard
American Express
Credit Card Account Number:
_________________________________________
Expiration Date:
_____/____/____________ *Security / CVL
Code: ____________
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Top of Form
*Note: For Visa and MasterCard this code is the last three digits
printed on the card's signature strip (back of card). For American Express
(AMEX) accounts, this is a four-digit code found on the front of the
card following the card number.
Bottom of Form
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I, as purchaser, hereby agree that
I have read and agree to the terms and conditions provided herein regarding
the use of this web site and all products / equipment contained or listed on
this site. I certify that I am 18 years of age or older and am capable of
receiving item(s) ordered. I further understand that it is my responsibility
to ascertain and obey any and all local, state, and federal laws regarding
the use of these products in my own state, province, or country. Furthermore,
I will not hold Eyespyvideo.com responsible or liable for any use or misuse of
its products. I grant permission for the credit card account above to be
charged for the full amount of products plus applicable shipping costs and
taxes (MO residents only).
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X____________________________________________________
Signature
REQUIRED for all orders by fax
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