Secure Online Order Form

Billing Information Name: Street: City: Province/State: Postal/Zip Code: Country: Home Phone: Work Phone: E-mail:

 

Shipping Information Name: Street: City: Province/State: Postal/Zip Code: Country:

 
 

	Game	System	Quantity	Price	Total
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
Item 9
Item 10
				Sub Total
				Shipping (See Below)
				Tax (NC Residents Only add 6%)
				Grand Total

 

Ship Via	UPS Ground $6.002 Items/Ground $7.003 Items or More/Ground $8.003 Day Select $8.002 Items/3 Day Select $9.003 Items or More/3 Day Select $10.00UPS Second Day Air $122 Items/Second Day Air $133 Items or More/Second Day Air $14Next Day Air $20.002 Items/Next Day $22.003 Items or More/Next Day Air $24.00Canada Orders 1 Item / $15.00Canada Orders 2 Items  / $18.00Canada Orders 3 Items / $20Canada Orders Game Systems / $30International Orders 1 Item $20.00International Orders 2 Items $25.00International Orders 3 Items / $30International Orders Game Systems / $50Game System Ground $9Game System 3 Day Select $12Game System 2nd Air $20Game System Overnight $30
Payment	Visa Mastercard Discover
Card Number
Name on Card
Expires	January February March April May June July August September October November December2001 2002 2003 200420052006 2007
Bank Name
Customer Service Phone Number (located on the  back of card)

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Special Instructions / Comments / If this is a Gift Add a Personalized Message

 

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