BaskWeb e-Commerce Shopping Cart System

BaskWeb E-Commerce System - Fax Order Form
To order via fax, use browser PRINT BUTTON to print this form, fill it out, and fax it to (248) 692-0342

Note: We will e-mail you to confirm your order.

Send me the following products (print out multiple sheets if necessary):
Product Name	Description	Comments	Price





MI Residents Add 6% Sales Tax
Shipping			FREE
Total

Contact Information:
Name (as shown on credit card):
E-Mail Address:

Billing Information:
First Name:		Last Name:
Address:
City, State (or Province), Zip:
Country:

___ Check here to ship to Billing Address above or fill out the following:

Shipping Information:
First Name:		Last Name:
Address:
City, State (or Province), Zip:
Country:

Payment Method: __ VISA __ MasterCard __ American Express

Credit Card # and Expiration Date: