Pillar Point Electronics, Inc. Order Form - Secure

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Qty
Product Description
Billing Address:
Name:
Company (Optional):
Street:
City, State, Zip Code: ,
Country:
Phone Number: () -
Email Address:
Click this box if the Billing and Shipping Address is the same.
Shipping Address (If different than Billing Address):
Name:
Company (Optional):
Street:
City, State, Zip Code: ,
Country:
Payment Method: VISA | M/C | DISC | AMEX | Check or Money Order
Click this box if you want us to contact you by phone to get your credit card information.
Card Number:
Ex-Date (XX-XXXX):
CSC# - Back(V-M/C-D) Front(AMEX):
Billing Zip Code:
It is our policy not to disclose any customer contact information to third parties.
Comments: Custom Legend Info, etc.
We charge $10.00 per order for shipping in the continental USA
and $20.00 for shipping anywhere else.
Orders shipped to a location in Florida are subject to 7.0% sales tax.
Please fill in the box below with the characters you see in the accompanying image. Thank you.