Order Form

1. Customer Information

Full Name: _____________________________________

Company Name (if applicable): _____________________________________

Phone Number: _____________________________________

Email Address: _____________________________________

Shipping Address: _____________________________________

City: ____________________ State: ____________ ZIP Code: ____________

2. Order Details

Please list the products or services being ordered:

Subtotal: $__________________

Tax (%): $__________________

Shipping: $__________________

Total Amount Due: $__________________

3. Payment Method

☐ Credit Card
☐ Bank Transfer
☐ PayPal
☐ Cash on Delivery

Other (please specify): ____________________________

4. Delivery Instructions

Preferred delivery date: ____________________

Special instructions:

5. Terms and Conditions

• All orders are subject to availability and confirmation

• Full payment is required before shipping (unless otherwise agreed)

• Returns and exchanges must be requested within [X] days of delivery

• Late payments may result in delays or cancellation

  
  

6. Authorization

By signing below, I confirm that I have reviewed and approved this order.

Customer Signature
Date: _______________

Authorized Representative (if needed)
Date: _______________