Cruzer Enterprises Order Form

Please fill in the following form and click on the submit button to place an order. Use your TAB key to go to the next entry field.

Item	Product Number	Qty	Price	Ext
1.
2.
3.
4.
Please remember to add 10% for shipping and handling. 15% for OSS and SSS style items. California Residents must add 8.25% sales tax		Subtotal
		Shipping & Handling
		Grand Total

Shipping Information:

Name
Street Address
City, ST ZIP
Telephone
Fax
Email Address

Payment Information:

We accept
Name on Card
Billing Address for Card
City, ST ZIP
Card Number
Expiration Date MM/YY

Comments or shipping instructions:


If you feel uncomfortable about submitting your credit card number over the Internet, leave the "number" area blank. In the comment area let us know you would like to fax your card number to us and we will email our fax number to you. Although we have had no problems to date, we will soon be implementing a more secure order process.