Printable Order Form
Print and complete this form. Then FAX it to: 530-918-9541 or MAIL it to:
Language Quest
309 N Mt Shasta Blvd
Mt Shasta, CA 96067 USA
BILLING ADDRESS:
Name___________________________________________________________________
Address_________________________________________________________________
City _______________________State _______ Zip _________ Country _______
Daytime Phone ____________________ FAX number _____________________________
E-Mail Address _____________________________
Payment: We accept Visa, MasterCard and American Express
Credit Card Number __________________________________________________________
Expiration Date ______________________________________________________________
Name as it appears on Card __________________________________________________
Signature of Card Owner _____________________________________________________
ITEMS ORDERED:
Item #1 ______________________________________ Price $_________
Item #2 ______________________________________ Price $_________
Item #3 ______________________________________ Price $_________
Item #4 ______________________________________ Price $_________
Item #5 ______________________________________ Price $_________
Item #6 ______________________________________ Price $_________
Subtotal: $_________
California Sales Tax (California deliveries only) @ 0.0775 (7.75%) $_________
Shipping & Handling (»Shipping Info): $_________
TOTAL Charged to your credit card or check amount $_________