CRIME BUSTERS 911 – FAX ORDER FORM – (954)499-4424

PLEASE COMPLETE THE FOLLOWING- PLEASE PRINT

ITEM DESCRIPTION QTY PRICE

1.

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2.

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3.

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sub total - __________________

shipping/handling- __________________

ADD $6.00 shipping 6-10 days, $11.00
for 3-4 days and $ 20.00 for 2 day express and
overnight delivery $35.00

tax (please add 6% in FLA) _________________

TOTAL ____________________

CUSTOMER INFORMATION

BILLING INFO.

1. NAME ON CREDIT CARD:_______________________________(EXACTLY AS IT APPEARS)
2. TYPE OF CARD:( PLEASE CIRCLE ONE) VIS –MST
3. CREDIT CARD NO:________________________________________
4. EXPIRATION DATE:__________________
5. PHONE NO: _ _ _ - _ _ _ - _ _ _ _ E-mail address __________________________

7. CREDIT CARD’S BILLING ADDRESS: ___________________________________

___________________________________

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SHIPPING INFO.

1. FULL SHIPPING ADDRESS: (IF DIFFERENT THAN BILLING ADDRESS)

____________________________________

____________________________________

____________________________________

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NOTE: ALL CREDIT CARD INFO. IS VERIFIED WITH ISSUING BANK BEFOR DELIVERY

PLEASE COMPLETE THE FOLLOWING:

I_________________________AUTHORIZE SECURITY CAMERAS 911 CORP/CRIME BUSTERS 911.COM PERMISSION TO CHARGE MY CARD THE AMOUNT OF $_____________________.

PLEASE FOR OUR TERMS AND CONDITIONS, PLEASE GO TO http:://WWW.CRIMEBUSTERS911.COM/TERMS.htm