ADDRESS INFORMATION
NAME
COMPANY
DAYTIME PHONE	(          )
EVENING PHONE	(          )
BILLING ADDRESS (must match Credit Card billing address)
NAME ON CARD
ADDRESS 1
State / Province
SHIPPING ADDRESS (no POST OFFICE boxes - - - please)
SHIP TO NAME
ADDRESS 1
ADDRESS 2
State-Province	Postal Code	Country

PRODUCT DESCRIPTION and QUANTITY

CREDIT CARD INFORMATION
CREDIT CARD NUMBER
EXPIRATION    Month  ___ ___     Year  ___ ___	M/C VISA AMEX DISCOVER
TOTAL AMOUNT
SIGNATURE	EMAIL:

INTERNATIONAL CREDIT CARD PURCHASES - 3 important steps
1.	Please Fax Front & Back Images of your Credit Card to: 214-594-8100
2.	Bank Email:
	Bank Phone:
3.	Fill this form out completely and fax to: 214-594-8100