Code 3 Customs
ORDER FORM

Print out this form, complete it and mail or fax to:
Code 3 Customs
P.O. Box 341428
Beavercreek, OH 45434
Phone: 937-431-1029
Fax: 937-431-1901

If using a credit card, please provide the BILLING address for the credit card so that it can be securely charged with your information.

Name:

Billing Address:

City/State/Zip:

Shipping Address if different than billing:

City/State/Zip:

Phone (w/ area code):

E-mail Address:

PAYMENT BY:
_______Check ________Money Order ________Visa ________ Mastercard________ Discover
-Make checks or money orders payable to Code 3 Customs.

Credit Card Number: __________________________________
Expiration date: ____/____
Name as it appears on Card: ____________________________
Signature:____________________________________________

I would like to order the following items:

** OHIO RESIDENTS PLEASE ADD 7.5% SALES TAX **

Quantity	Description	Price
Subtotal
Ohio residents please add 7.5% sales tax
Shipping and handling (use pretax subtotal amount)
Total