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Ergomotion Accessory Order Form

This document is an accessory order form containing fields for a customer to enter their billing information, shipping information if different, credit card information, shipping method selection, and order details including quantity, item SKU, description, item price and total. The customer would complete the form and submit it via email or fax to place an order for accessories with the company Ergomotion Inc. Shipping and handling costs vary depending on address, weight, and shipping speed selected and range from $15-100.

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Ehler's Furniture
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© © All Rights Reserved
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197 views

Ergomotion Accessory Order Form

This document is an accessory order form containing fields for a customer to enter their billing information, shipping information if different, credit card information, shipping method selection, and order details including quantity, item SKU, description, item price and total. The customer would complete the form and submit it via email or fax to place an order for accessories with the company Ergomotion Inc. Shipping and handling costs vary depending on address, weight, and shipping speed selected and range from $15-100.

Uploaded by

Ehler's Furniture
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Accessory Order Form

Date:________________

Billing Address: Shipping Address:


Same as Billing

Name:__________________________________________________ Name:__________________________________________________

Retail Store:_____________________________________________ Retail Store:_____________________________________________

Address:________________________________________________ Address:________________________________________________

City:___________________________________________________ City:___________________________________________________

State:____________ Zip:___________________________________ State:____________ Zip:___________________________________

Phone Number:__________________________________________ Phone Number:__________________________________________

Credit Card Information:


Method of Payment: VISA MASTERCARD AMERICAN EXPRESS

Name as it appears on card:____________________________________________________________________

Card Number:________________________________________________________Expires:________________ CVV Code_____________

Shipping Method:
Ground (1-5 days) 3 Day Select 2nd Day Air Next Day Air
*Shipping and Handling: Varies by address, weight of shipment and selected shipping method. Shipping prices range from $15-100.

Order Information:
QTY SKU DESCRIPTION ITEM PRICE TOTAL

TOTAL*
Email or fax this completed form to: E: [email protected] -or- F: 805-979-9399
(excludes shipping)

Thank you for your order.

Ergomotion Inc. | ph 1-888-550-3746 | fx 805-979-9399 | www.ergomotion.us

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