ORDER FORM
For quickest, most secure service, fill out form and Fax to 561-487-1439.
Or you can fill out form online and hit "Submit" button at bottom of page.
QTY.
STYLE #
ITEM DESCRIPTION
PRICE
TOTAL
  Promotional Code
 
  Prepaid Order: Check or Credit Card Okay. Orders under $250.00 must be prepaid
  (Make checks payable to C.D. & M., Inc.)
Sub Total
  Net 15 - Open account terms   **Must be pre-approved and will be considered based
  upon submission of credit references.  (Make checks payable to C.D. & M., Inc.)
Freight
  Your Event Date:
Grand Total
  Date Order Needed:
Personalization Instructions
SHIPPING ADDRESS


 Name: Title:

 Organization:

 Shipping Address: Suite:

 City: State: Zip Code:

 Phone: Ext.: Fax:

 E-Mail: # of Volunteers:

CREDIT CARD INFORMATION

 Type of Card:   Card Number:   Exp:

 Name as it appears on card:

 Billing Address:

 City: State: Zip Code:

 Signature: _______________________________________________________________