Antenna Ball World: Credit Card Order Form

To use a credit card Click Here to Print this form and fax to (925) 456-2274 or mail to Antenna Ball World 1141 Catalina Drive Suite #157; Livermore, CA 94550
United States Credit Card Orders Only.

Billing Address:

Name:_______________________________
Address 1:__________________________
Address 2:__________________________
City:_________________State:________
                 Zip Code:__________
Phone:(      )_______-______________
Email:______________________________

Ship To:

Name:_______________________________
Address 1:__________________________
Address 2:__________________________
City:_________________State:________
                 Zip Code:__________
Phone:(      )_______-______________

Credit Card Information:

Name on Card:_______________________
CC #:_______________________________
Expiration: _______/________
Visa[] MC[] Discover[] AmEx[]
Security Code:_______
Signature:__________________________

Shipping Information:

    Order Total     | Shipping Cost
 -------------------+--------------
    $0.01 -   $9.99 |    $5.75
   $10.00 -   49.99 |    $6.75
   $50.00 -   99.99 |   $13.75
  $100.00 - $199.99 |   $19.75
  $200.00 and over  |   $23.75

Please add US$2.25 to Canadian Orders

	Description	Quantity	Price	Total
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
			Subtotal	_____
	9.75% sales tax for CA state residents.		Sales Tax	_____
	Canadian residents add an additional US$2.25. to shipping. Please Check the Above Shipping table for rates.		Shipping	_____
			Total	_____