MW Computer Design & Service Order Request Form Fax: 775.370.2037 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, PayPal (At this time we only accept credit cards with our online store front orders.) 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:___________________________