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BDSM Store
www.bdsmstore.com
OFF-LINE ORDER FORM
| NAME:
___________________________________________ |
| STREET ADDRESS:
_____________________________________________________________ |
| CITY:_____________________________ |
STATE:________________________ |
ZIP:
______________ |
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COUNTRY: _________________________ |
| TELEPHONE:
_____________________ |
E-MAIL: ______________________________________ |
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SKU |
QTY |
DESCRIPTION |
COLOR
If applicable |
SIZE
If applicable |
PRICE |
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Sub-Total |
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(Michigan Residents only - add 6%) Sales Tax |
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(See
Website for shipping options and fees - Domestic Ground Shipping
Starting at Only $6.95) Shipping |
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Order Total |
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| PAYMENT INFORMATION: |
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| Money Order:
__________ Make payable to:
CY Worldwide, Inc. (We do not accept
personal checks) |
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| Credit Card:
___________ |
Circle one:
Visa
Mastercard
American Express
Discover |
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| Credit Card #:
______________________________________________ |
Expiration Date: _________________ |
| Security Code:
____________ |
(3 digit
for Visa, M/C and Discover located on back strip at far right)
(4 digit for American Express located on front just above credit
card number) |
SEND YOUR ORDER:
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| By Mail: |
CY Worldwide,
Inc.
P.O. Box 866
Clarkston, Michigan 48347
U.S.A. |
By Fax: |
1-877-878-2376 |
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