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MANUAL ORDER FORM

Please complete this form, Fax/Mail it and order will be processed soon.

220Converters.com

1252A,Remington Road
Schaumburg, IL-60173-USA
Inquiries: (847) 519-1201   Fax: (847) 519-1270
E-mail:sales@220converters.com

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Sales Tax @ 8.25% For Illinois Customers Only.  
Shipping Charges  
Grand Total $

Please Call Us For Shipping Charge Details.

Payment Information
Card Type ___________________________
Card Number
___________________________
[16 Digit Account No.]
Expiration Date ___________________________
Card Issuer(bank) name & Phone No. ___________________________

Card Holder Information or Billing Address
Salutation Mr. Ms. Mrs.
First Name : _____________________________M.I.____
Last Name : _____________________________________
Company Name : _____________________________________
Address : _____________________________________
[Address where credit card statements are received]
City : _____________________________________
State/Province : ________________Zip: _________-________
Country : ______________________________________
Phone No. : ______________________________________
[For Security reasons, it may be necessary to contact you at this phone number before your order is shipped]
Email : ______________________________________

Shipping Information
Salutation Mr. Ms. Mrs.
First Name : _____________________________M.I.____
Last Name : _____________________________________
Company Name : _____________________________________
Address : _____________________________________
City : _____________________________________
State/Province : ________________Zip: _________-________
Country : ______________________________________
Phone No. : ___________________________________
Special Shipping Instructions: ___________________________

By providing above information, you authorize us to charge on your credit card for above purchase order.

Please see return policy page for our return policy.

 
220Converters.com 1252-A, Remington Road, Schaumburg, IL 60173, USA Phone: 1-847-519-1201 Toll Free: 1-877-443-1212 Open Monday-Friday 10:30 AM-7:30 PM CST
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