Credit Card Order Form

Please input your information using this form. It can be filled out and printed for your convenience.
Please note that when filling out the form you should hand write your credit card information as it is not safe to
input credit card information on the internet. Thank you for your cooperation.

	Ship to Address:
Center Name
Address	City State
Country	Zip -
Phone	Fax E-Mail
	Bill to Address: check here if same as ship to address
Name
Address	City State
Country	Zip -
Credit Card Information	Visa MasterCard Discover Card Number - - - Expiration Date (mm/yy) CV2 3 digit security code on back of credit/debit card
Item 1	Quanity Model # Description
Item 2	Quanity Model # Description
Item 3	Quanity Model # Description
Item 4	Quanity Model # Description

Please fill in type of equipment for each catagory.

Pinsetter Automatic Scoring Foul Units