Shoko's Fax Order Form

Shoko's Fax Order Form. Please fill out everything except your credit card information then print the form. Add your credit card information by hand and fax to 540-348-3442 No AMEX Card, Pay Pal, personal checks, or foreign based credit cards accepted for faxed orders.
Shipping costs are based on weight and UPS zones. If you need to know the exact cost before ordering, please call us at 1-800-654-4394 and we will be happy to determine your exact charges.

All personal and sales information submitted is kept in the strictest of confidence.
No personal information will be sold or shared with a third party.

Full Name :
Have you ordered from us in the past? YES or NO. If you have moved since your last order, we will need your old address.
Shipping Address: Required Include your Apartment # and or PO box number if you have one.
City:
State:
Zip Code / Postal Code
Mailing/Billing Address if different from shipping address. Include Po box, City, State & Zip Code :
Telephone (Day) : required
Telephone (Evening) : required
E-mail: Please Note: (If you make a mistake we will need your E mail address to contact you)
Payment Type: required. For U.S.A. Canada, Puerto Rico, Guam or the US Virgin Islands. All other orders please click here first.	Visa MasterCard Discover
MasterCard, Visa or Discover Account # : Please double check this number. It should have 16 digits. Fill in by hand.
Card Expiration Date : required
Card Security Code: required The 3 digit security code is located on the back of your credit card, on the line where you sign your name. It is a small 3 digit number that follows the last 4 digits of your credit card number.
Card Holders Name : required
Automatic Orders? : If you have selected an Automatic buyers price, we need to know how often you would like the product shipped. We will not ship any product to you automatically without your request.

ITEM#	DESCRIPTION	UNIT PRICE	QTY	AMOUNT