QualityMathProducts Fax Order Form


GNHC – QualityMathProducts Division

30 Ham Street, Dover, NH 03820
Fax:603-866-2864

Date:___________________

 

YOUR SHIPPING INFORMATION                      
YOUR BILLING INFORMATION
Name:__________________________________ Name:__________________________________
Shipping
Address:___________________________
Billing
Address:_________________________
_______________________________________ _______________________________________
City:_______________________ City:_______________________
State:_____________
Zip:____________
State:_____________
Zip:____________
Country___________________ Country___________________
Phone:____________________________
(Required)*
Your
Email
:________________________
(Required)*
 

Item
No#
 Description 
Quantity
Price
Per Unit
Total
Price
         
         
         
         
         
Sub-Total  
Shipping (See Below)  
Total  

Faxed orders received
after 2pm CST will be processed on the next business day. Mail In
Only, Make Payment to: The QualityMathProducts. Order will ship after check
clears banking systems. Money orders ship upon receipt. International must
supply US Bank Draft for total in US Dollars only.

Card
Number:_________________________________________________EXP:________ 


3-4 Digit Security Code _______
(required!*)
Visa,
MC, Disc: Last 3 digits on back of card in signature line. AMEX (only)
can also be located on front of card 4 digits for older verions of the
card.

Clear
Signature:_______________________________________________________________

Print Exact Billing
Name___________________________________________________

Card CVV2:___________

Shipping
rates as follows:


Regular
Shipping 
7-10
Business Days
$6.95 No Item Limit
Rush
Shipping 
3-4 Business
Days
$17.95  No Item Limit
International,
Military,
HI, AK
Quote Only Contact
Customer Service
Contact
Customer Service