PrestigeTime Fax Order Form

Concerned about Web Security and don't want to give out your Credit Card information? At Prestige Time we respect your concerns and have an alternate solution - just fill out this form, print it, then fax it to us at +1-845-357-8320. You may also print it blank and fill it out by hand.
Note: This is not an interactive form.


Item Description
Manufacturer's Name   Series  
Model #    Quantity  
Cost as seen advertised  

Shipping to NY is subject to NYS and County taxes.

Shipping Info
Name     
Address  
              
City          State    Zip Code  
Country   
Contact Tel #  (include country code if outside of USA)  
Best time to call  
E-mail Address  

Billing Info All information must be identical to that on your credit card.
Credit Card Type  (Visa, MasterCard, American Express, Discover)
Credit Card Number  
Expiration Date   CID No.   (Visa, MasterCard & Discover - the last 3 digits printed on the reverse side of your card - usually on the sinature panel. American Express - the 4 digit number printed on the face of the card directly above the last numbers of the credit card)

Name and address must be as appears on your bill.
Name     
Address  
              
City          State    Zip Code  
Country   

Shipping Options:
Fed Ex Standard (3-4 days) FREE - Continental USA Deliveries only
Second Day Air $20 - Continental USA Deliveries only
Next Day Air $30 - Continental USA Deliveries only
Priority Next Day before 10.30am delivery $40 - Continental USA Deliveries only
Fed Ex Shipping to Canada, PR or US Virgin Islands $40.00
Fed Ex International $70.00 - All countries except for Canada

Card Holder Signature ____________________________________________

Date ______/_______/________


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