QualityMathProducts Fax Order Form


GNHC – QualityMathProducts Division

62 Calef Highway Suite 108

Lee, NH 03861

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: 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