CopsPlus.com Customer Order By Fax
Instructions: To place your order by fax, print this form, then fill out the appropriate information below. Be sure to include a complete description of each item including all options such as color, finish, gun fit, etc. Also complete the “Ship To” and “Bill To” sections including your credit card payment information. Fax orders are to be submitted to (718) 267-7029. Note: Fields that are in bold are required. Order Date: Friday May, 9 2008
Ship To Information		Bill To Information (As on Credit Card)
- First Name:		- First Name:
- Last Name:		- Last Name:
- Email Address:		- Email Address:
- Agency:		- Agency:
- Address:		- Address:
- Address:		- Address:
- City:		- City:
- State:		- State:
- Zip Code:		- Zip Code:
- Phone Number:		- Phone Number:
- Fax Number:		- Fax Number:
Credit Card
- Credit Card Type:      Master Card      Visa      IMPAC      Discover      American Express
- Name on Credit Card:
- Credit Card Number:
- Credit Card Expires:
Order Detail
0	QUANTITY    /    ITEM NAME    /    PRICE
	OPTIONS (COLOR, FINISH, SIZE, GUN FIT, RIGHT/LEFT HANDED, ETC.)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
When Complete, Fax To (718) 267-7029