|
Credit Card Type [ ] Visa:: [ ] Mastercard: [ ]Discovery: [ ]AMEX: 3 digit Credit Card Code (on Back) _____________
Card Number: ___________________________________________________________ Expiration : Month _________ Year______________
Address on Card if different from Orderer: ________________________________________________________________________________
City ________________________________________________________State __________ Zip ______________________
Shipping is $5.00 for each separate address to which an order is shipped regardless of the number of items ordered. You may call or fax your order to 925-625-5818 or mail to A.S.Gayle Associates, 2063 Main Street, #160, Oakley, California, 94561.
|