Print This Page


MW Computer Design & Service

Order Request Form

Fax: 866.516.8162
Phone: 989.786.4605

Shipping Information:

Name:_____________________________________________

Company:__________________________________________

Street Address: (No Post Office Box)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

City:_________________________ State:_________________ Zip Code:______________

Telephone: (Day) __________________ Telephone: (Evening) _______________________

Fax:______________________ Email Address:___________________________________


Billing Information:

Name: (As it Appears on your credit card) _______________________________________

Address: (Where your credit card statements are Mailed to)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

City:_________________________ State:_________________ Zip Code:______________

Telephone: (Day)____________________ Telephone: (Evening) ______________________





Product Order Form

Product Item Num#: Price Quantity Total Price
1. . . .
2. . . .
3. . . .
4. . . .
5. . . .
6. . . .
7. . . .
8. . . .
9. . . .
10. . . .
O Local & Cashier's Check or Money Order

Sub Total:

.
O Visa, MasterCard, Discover, America Express

(At this time we only accept Credit Card via our website "Pay Your Invoice" button or by phone with WePay.)

Tax:
(MI. 0.06%)

.

Shipping & Handling:

.
Credit Card Bank Name:

Total:

.
Credit Card Name:

Credit Card Holder Signature:

.

I have read and understand MW Computer Design & Service, Sales Terms & Conditions and have read the
Shipping Charge Policies.

Signature:___________________________________ Date:___________________________