Order Form

                                                                           For office use only     

        Online:   Order online at our secure site  www.chicool.com                        Custom #

          Checks:  Make Cashier’s checks payable to Chicool             

            Fax:        (703) 268-5686                                                                            Order #

            Phone:    (703) 268-5686                                                                                    

          Mail:          Fill out the order form and send it to

                              Chicool   P.O. Box 71  Merrifield,  VA 22116  

 

Billing Address:

Shipping Address: (If Deferent from billing address)

Name/School

Name/School

Address

Address

City

City

State/Zip

State/Zip

E-mail

E-mail

Phone#

Phone#

Order:

PRODUCT #

DESCRIPTION

QTY

UNIT PRICE

TOTAL

Shipping and Processing Charge

SUBTOTAL

Order Total

$0 - 24.99

$25 - 49.99

$50 -74.99

$75 -99.99

$100 +

SALES TAX (Virginia only 5%)

Shipping

$7. 95

$9. 95

$11. 95

$13. 95

$16. 95

SHIPPING & PROCESSING

TOTAL

 

Payment Method: Check one    ( US Funds Only)	International Orders:
Cashier’s Check or Money Order (Enclosed)        MasterCard                          Visa Cardholder’s Name:__________________________   Credit Card #    Expiration Date:               Credit Card Verification # (Required)       Last 3 digits on the back of your card   Authorized Signature X ________________________	* All international orders must be prepaid in full with      U.S. funds, by a cashier's check drawn on a U.S.     bank or by wire transfer. * We will inform you via email for the exact shipping     cost after your order is placed. * All shipments are sent via United States Postal    Service. Delivery may be completed by a local    shipping courier.   Thank You for Ordering