Make your own free website on Tripod.com

TOMAR Entertainment

This is a secured server page. Your data is safely encrypted and is safe from unauthorized access.

Customer Information

*Full Name:

 

Company:

 

*Day Phone:

 

Home Phone:

 

Fax:

 

*Email:

 

*Address1:

 

Address2:

 

*City:

 

*State:

 

*Postcode/Zip:

 

*Country:

 

*Indicates a REQUIRED FIELD

 

Please tick this box if you wish us to remember your personal information for future purchases.

Shipping To Information

Fill in if different to above address.
 

Ship To Name:

 

Ship To Address1:

 

Address2:

 

City:

 

State:

 

Postcode/Zip:

 

Country:

 

Credit Card Payment Information

Name on Card:

 

Card Type:

 

Card Number:

 

Expire Date:

 

Month: Year:

Product Information

Qty

Description

Total

BASE Video   $39.95

$

Product Total

$

Enter Tax Rate %     Taxes

$

Shipping Method

Grand Total

$

Please note: Orders will be shipped by PRIORITY MAIL. Next Day Air shipping available upon request. If you would like to mail in payment you can print out this order form and mail with your cheque or money order to: TOMAR Entertainment PO Box 347 Wollongong East NSW 2520 Australia

 

Comments/Questions/Special Delivery Information?

Any further

I authorize TOMAR Entertainment to charge my credit card for the above total  I further affirm that the name and personal information provided on this form are true and correct.

By pressing the ORDER button below, I agree to pay TOMAR Entertainment.