Computer

Computer-furniture.com 256 East Jericho Tpke, Mineola,NY 11501 1-516-967-5560 Mon-Fri 8:00 am - 5pm EST Fax: 516-747-4941 E-mail: cyrus@computer-furniture.com
We accept company check, bank check, money order, or major credit card and purchase order with this order form.

DATE:

ORDERED BY: (Please Print)
Customer Name

SHIP TO (if different than purchaser)
Name

Address

City____________________St___ ___Zip

City________________St_____Zip

Phone # ________________________Fax #

Recipient Phone #

Daytime Phone #

E-mail Address

_ ITEM #

_ QTY

_ ITEM DESCRIPTION

_COLOR

_ UNIT PRICE

TOTAL

PAYMENT METHOD: (Circle One)

AMEX _____ VISA _____ MASTERCARD _____ DISCOVER

MERCHANDISE
TOTAL

CREDIT CARD #:

SHIPPING CHARGE

EXPIRATION DATE: (MM/YY)

$0.00

NAME ON CARD:

SUBTOTAL $

SIGNATURE:

SALES TAX $0.00

TOTAL

H.T.C Inc. ships within the Continental United States. For all orders shipping to Alaska, Hawaii, APO,FPO and International destinations, special shipping costs apply.
**Orders to ship within 2 business days ** Allow 10 business days for delivery.