Mr. Hi FAX Order Form

To place a fax order, please print this form with your browser's print function, fill it in, sign it, and fax it to us at 847-647-0428. The fax order desk is open 24 hours a day, 7 days a week.

STEP 1. Enter the product(s) you wish to order and the shipping charges here. Ordering Information and Shipping Charges are shown in the shipping rate tables in Section 3 of the Insurance, Shipping & Handling section of the Order Information page. Insurance is optional at $4.00 per order.

Item Quantity Model/Description Price (each)  Total 
#1            
#2            
#3            
#4            
#5            
         Insurance ($)   
         Shipping ($)   
         Total ($)   

STEP 2. Enter payment method here (VISA / MasterCard only). Note that all credit card orders are subject to electronic verification using address authentication.

Credit Card Type:   
Credit Card Number:   
Card Expiration Date:   
Cardholder Name:   
Phone Number:   
Address:   
Address:   
City:   
ZIP/Postal Code:   
Country:   
E-Mail:   

IMPORTANT: Your signature below must be for the cardholder shown above, and also indicates that you have read and agree to the standard terms and conditions on the Order Information page. Orders submitted without this signature will not be processed.


Signature (for fax orders): ____________________________________________

STEP 3. If you have a different 'ship to' address, enter it here. You must include phone numbers for the shipping address.

Name:   
Phone Number:   
Company:   
Address:   
City:   
State/Province:   
Zip/Postal Code:   
Country:   

STEP 4. Additional notes and comments for this order:

 
 
 

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