Billing Information/Payment Amount $__________
Check, Money Order, Visa or MasterCard, AmEx,
Discover (circle one)
Acct#___________________________
Expiration date_________________
Billing name & address if different from shipping info
_______________________________
_______________________________
_______________________________
Product Selection
Item Description____________________
Item #_________________________
Quantity_______________________
Size___________________________
Color__________________________
Price__________________________
Shipping cost__________________
Product selection
Item
Description___________________
Item #________________________
Quantity______________________
Size__________________________
Color_________________________
Price_________________________
Shipping cost_________________
Print this form, fill it out, and mail to FLEX-MATS Inc.
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