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Order Form

Fax Order Form

Print this page, fill it out completely and fax to 847-918-9438 or mail to:

Catalog Clearance
632 Innsbruck Court
Libertyville, IL 60048

Please include either a check made payable to Catalog Clearance or your credit card information.

Item #

Description

Price

Qty

Total

         
         
         
         

Sales Tax 6.5%
Illinois Res. Only

 

Shipping & Handling

 

Total

 

 

Keycode: ____________

 

Personal Information

Name: ____________________________________

Address: ____________________________________

City:____________________________________

State:__________________

Zip: __________________

Phone Number:(____________)_______________________

Email Address: ____________________________________

 

Payment Method (please check one)

_____ Visa

_____ MasterCard

_____ Discover

_____ Check

Expiration Date ______________

Account # __________________

How would you like to be contacted?

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