Online Purchase Order

BILLING/CONTACT INFORMATION

(Please provide the following required contact information for your order)

If paying by credit card, then all information in this section should be for the authorized cardholder only

CUSTOMER NAME......:

MAILING ADDRESS.....:

CITY, STATE, ZIP CODE:

TELEPHONE.................: *REQUIRED

EMAIL ADDRESS.........: *REQUIRED

*Please make sure you entered your email address carefully. This is the primary means we will use to respond to your PRICE

QUOTE or ORDER request. Your request will NOT be processed without a VALID email address and phone number.

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ORDER LISTING

(Please provide the following ordering information for each item ordered in the area provided)

Quantity         Item                            Item                                                                                                                                           Unit                             Total

Ordered          Number                    Description                                                                                                                             Price                            Price

Note: If more lines are needed, please submit additional orders.

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DELIVERY INFORMATION

Most packages are shipped via UPS ground. Standard Shipping/handling charges within the continental US and to APO/FPO boxes are as follows: Up to $25.00 = $6.95; $25.01 to $75.00 = $9.95; $75.01 to $100.00 = 12.95 $101.00 to $150.00 = $14.95; or actual postage, whichever is greater. Some items may require additional delivery charges and delivery time due to weight.

To order by mail, please complete and print our Customer Purchase/Shipping Invoice:

Customer Purchase/Shipping Invoice (Pdf.) ● Customer Purchase/Shipping Invoice (Doc.)

And send it along with your form of payment to the following address: D. Sonny Drew ● 4946 St. Lawrence Avenue ● Chicago, IL 60615

METHOD of SHIPMENT:

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ORDER TOTALS

SUBTOTAL............................ :

SALES DISCOUNT..................:

SHIPPING INSURANCE..........:

SALES TAX 9.25 (ILL ONLY).....:

TOTAL AMOUNT SUBMITTED:

PAYMENT METHOD..............:

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CREDIT CARD PAYMENT ONLY

(Use our "PayPal Pay Now" Button to make payment)

CREDIT CARD TYPE............:

NAME (As appears on Credit Card)...................:

CREDIT CARD NUMBER (Without dashes).........:

3 DIGIT VERIFICATION CODE (On back of card)..:*REQUIRED

*For your safety and security, we require that you enter your credit card's verification code . This verification code is printed on the back of the card and appears after and to the right of your card number.

CARD EXPIRATION DATE (07/04).......................:

BILLING ADDRESS (If difference from mailing)..:

AUTHORIZED CARD SIGNER ..............................:

KEEP MY CARD INFORMATION ON FILE..........:

CONSENT: This is advised that D. Sonny Drew is authorized to accept orders from me by email, telephone, or fax; charge the cost of such orders to my credit card account; and ship the merchandise to the address that I provided. I accept all responsibility for transactions and ensure full payment to the merchant. Additionally, I will inform you immediately if use of this card is no longer valid.

ACKNOWLEDGE CONSENT..........:

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Additional Comments:

Please provide any additional comments or special instruction if applicable.