Order Form

Order

Form

3100 Pebble Dr SW
Cedar Rapids IA 52404
Phone 319-389-4527
Email sales@importgo.com
Website www.importgo.com

Order Information Item name	Art#	Quantity	Price	Total
_______________________________________	_________	_________	__________	__________
_______________________________________	_________	_________	__________	__________
_______________________________________	_________	_________	__________	__________
_______________________________________	_________	_________	__________	__________
Subtotal (Iowa residents add 5% tax)				__________
Freight				__________
			Total	__________

Billing Information Please list your billing address. This is also the address to which products will be shipped unless otherwise specified below.
Name _______________________________________ Phone (______)_______-________
Address ___________________________________________________________________
City ____________________________ State _____________ Zip _________________
Email _____________________________________________________________________
Credit Card (Circle one): Visa / Mastercard / American Express
	Card# _________ _________ _________ _________ Expiration MM/YY) ___/___
	Signature _______________________________ Date Signed _____/_____/_____

Shipping Information
Only complete this area if you would like the products shipped to an address other than the one listed above (i.e. a gift).

Name ______________________________________ Phone (______)_______-_________

Address ___________________________________________________________________

City _____________________________ State _____________ Zip ________________

Special Instructions
Note any special instructions below:

___________________________________________________________________________