Mail / Fax Order Form

Instructions:

  1. Print this form.
  2. Fill in all blanks completely.
  3. If sending your order by mail, send this form, along with a money order or cashier's check to: Clips'N'Stuff, 2303 Waverly Dr., SE, Albany, OR, 97322.
  4. If you are faxing your order, include your credit card information, and fax it to 1-541-967-1091.

Your order will be shipped within one business day. 

Your full name:___________________________________________________________________

Your credit card billing address:_________________________________________________

Your MAILING/SHIPPING address (if different than your credit card billing address): 

__________________________________________________________________________________

City:_____________________________________ State:__________  Zip code:____________

Credit card type (circle one):   Visa   MasterCard   Discover   American Express 

Credit card number (Write digits and spaces exactly as they appear on your card. 
The V-code can be found on the back of your credit card on the signature line. 
It is usually a 3 or 4 digit number): 

__________________________________ Exp.____ /____ V-Code: _______

The following information will be used only if there's a problem with your order:

Your telephone number: (_____)____________________________ (optional)

Your e-mail address:______________________________________ (optional)


Please list the product(s) that you are ordering, with quantities. 
Attach additional sheets, if necessary.

ITEM NAMES                                             QTY.     PRICE

_____________________________________________________  ____ X $_______=_______

_____________________________________________________  ____ X $_______=_______

_____________________________________________________  ____ X $_______=_______

_____________________________________________________  ____ X $_______=_______

_____________________________________________________  ____ X $_______=_______

                                                           SUBTOTAL: $________

                                              SHIPPING & HANDLING: + $________

                                                              TOTAL: $________