If paying by check or money order, please enclose payment with your order. If paying by credit card, please include the credit card number below, along with a signature in the signature box.
TYPE OF CREDIT CARD:________________________________
CREDIT CARD NUMBER: ________________________________
EXPIRATION DATE: ___________________ Security Code:_____________________
Please fill out the mailing address if it is different from your shipping address, and/or if the shipping address is different from the billing address on the credit card you are using. When you fax or mail the order form, please sign this sheet in the appropriate box below when paying by credit card.
Please note: by signing this order form you are agreeing that your credit card billing address is either the same as the shipping address, or is the mailing address listed below. This authorizes Wikco Industries to ship your order to the shipping address listed on this form.