Charge Card Information
For Shipping:
Call in, Fax, or E-Mail this information to us to process your order
Name: ________________________________________
Shipping Address: _______________________________
_______________________________
_______________________________
Billing Address: ________________________________
________________________________
________________________________
Phone #: ______________________________________
Card #: _______________________________________
Exp Date: ________/_________
Verification Code: _______________
Approx. Ship Date: _____________________________
Order: ________________________________________
________________________________________
_______________________________________
_______________________________________
Phone - 1-49-582-4321
Fax - 1-419-582-3013
E-Mail - winnersons@midohio.twcbc.com
