 IR Imaging Resources |
FAX ORDER FORM |
| A Division of Noops International, Inc. |
Attn.:____________________ |
| 20315 Nordhoff Street Chatsworth, CA 91311 USA |
Dated:___________________ |
| USA/Canada: (800) 220-2520, Fax (800) 220-2080 |
Time:____________________ |
| International: (818) 727-9740, Fax (818) 998-8239 |
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| ir-usa.com, E. Mail: irinfo@earthlink.net |
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| BILL TO: |
SHIP TO: |
| Acct. Number:_____________________ |
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Check Here If Same |
| Company Name:____________________ |
Company Name:__________________ |
| Address:__________________________ |
Address: _______________________ |
| City:__________St:______Zip_______ |
City:_________St:_______Zip:______ |
| Confirm to:_______________________ |
Confirm to:______________________ |
| Customer P.O. No.________________ |
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| Payment Method: |
| ____________Pre-Approved Terms |
| ____________COD |
| ____________Credit Card#______________________Exp.
Date________________ |
| MasterCard, VISA, American Express
and Discover Cards Accepted. |
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| Shipping: |
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Other Shipping Method |
| ________Standard |
_________________________________ |
| ________Red, Next Day Air,______AM |
_________________________________ |
| ________Blue, 2nd Day Air |
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| ________Orange, 3rd Day |
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| Back |