BASICTEMPLATES.COM: Mail-In and Fax Order Form
Complete all information below and mail it or fax it. IMPORTANT: The cardhold NAME and ADDRESS *must* match the name and address on your monthly billing statement or the transaction will be declined by your credit card company. We have no control over whether they approve or disapprove the transaction based on this criteria.


Your Name _________________________________________________________________

Your Address __________________________________________________________

City ________________________________ State _________________ Zip ____________

Country ______________________________________

Telephone: _________________________________ (landline only - no cellular)

Email: ______________________________________ (Must be your real ISP email or web site email address. Orders placed using free anonymous email accounts such as Hotmail, Yahoo, Excite, Mail.com, will not be processed.)

Method of Payment: Credit Card ______ Money Order ______ (checkmark one)

If paying via credit card, sate Card Number: ________-_________-_______-_______

Expiration Date: _______________ (We accept Visa, Mastercard, Discover, Amercian Express only.)

Security Code: _________ (3-digit code on the back of all types of credit cards)

List items you are purchasing below:

Item __________________________________________________ Price __________

Item __________________________________________________ Price __________

Item __________________________________________________ Price __________

Item __________________________________________________ Price __________

Item __________________________________________________ Price __________

* Outside of the USA and sending a Money Order?
(add $10.00 bank cashing charge) ............... $ ___________ (We are charged $10.00 USD to cash an international money order. If you are outside of the USA and sending a money order, you must include this additional fee or your money order will be returned.)

Total enclosed or charged to your credit card: $ _________________US Dollars

Name on Credit Card: ______________________________________________________

Signature of Cardholder: ___________________________________________________

Date: ______________________________________

Comments: ________________________________________________________________

 

Mail money orders to: BasicTemplates.com, PO Box 342, Belle Valley, OH 43717 USA
Fax credit card payments to: (877) 704-0548 [Extension 1, Option 2]