Order Form
Order Form

  • Please fill out the order form below, print and fax/mail it to us

    E-mail Address*:
    Company Name: Tax ID #:
    Your Name*:
    Billing Address: Street*:
    City*:
    State/Province*: Zip*:
    Country*:
    Phone*:

    Fax:
    (CHECK HERE if billing and shipping information are the same.)
    Shipping address is for Business or Residential
    Shipping Address: Street:
    City:
    State/Province: Zip:
    Country:
    Phone:

    Fax:

    Item #
    Unit Price
    Quantity
    Unit Price x Qty

    (Use additional sheet if needed)

    -Shipping charges will be calculated after receiving your order-

    Select the Shipping type:

    Payment Type:



    		Master Card Visa AMEX Discover PayPal (sales@gzintlinc.com)
    Money Order/Checks (See below for mailing address)
    Name on Card:
    Credit Card Numbers:

    *Issue Number(CVV code):

    *(the last 3 digits of security code on the reverse of card / 4 digits for AMEX at the front)
    Expiration Date:

    (e.g. mm/yyyy)
    Comments/Special requests:

    _________________________________________Cardholder Signature*

    (By singing above, you agree to the Cardholder Agreement and G&Z; 'Merchant Policy')

    *If paying by check or money order, make payable and mail to this address-------------->



    Rebecca's Design
    313 S. San Pedro St., Suite #101
    Los Angeles, California, 90013
    Phone: (213)628-7888   Fax: (626)289-8629

    Thank you for your business!

    Copyright 2007 Rebecca's Design.?All Rights Reserved.

    Web Site: http://www.gzintlinc.com