Mail & Fax Order Form

FAX-MAIL
ORDER FORM

Kitchen-Mart

333 Kingston Dr.
Florence, AL 35633
Hours 9:00am - 5:00pm cst. Mon-Fri
(256) 366-6163 Phone
(256) 767-4978 Fax
www.Kitchen-Mart.com

Ship To:

First Name:	.	Last Name:	.
Address:	.
City, :	.	State:	.
Zip Code:	.	e-mail:	.
Phone:	( )	Date:
Special Instructions:	.

Order:

Item #	Item Description	Qty.	Price	Extended
.	.	.	$	$
.	.	.	.	.
.	.	.	.	.
.	Faxed or Mailed Orders are Charged $5.99 Flat Rate Shipping, for UPS Ground..	.	.	.
			Shipping	$5.99
			Total	$

------------------------------------------------ Card Number -----------------------------------------------

Exp

_______________________________________________
Signature of Cardholder…

I authorize Kitchen-Mart to charge the credit card number indicated above for the total above plus sales tax (if applicable). I certify that the credit card number and signature above agree to the "Ship To address shown", as such, I am an authorized signer on this card.

Payment Info:

Note: These are the only forms of payment we accept (we do not accept personal checks).

Visa, MasterCard, Discover & American Express Only.

Shipping Options
(Note: Order Minimum is $20.00 - Please contact us for Export Orders.)

Money Order Instructions - mail completed order form along with a Money Order or Cashiers Check,
from a major bank, to address above.

If you need additional lines on the order form, print the order form twice and fill out 2 copies of page 1

PayPal Payments to info@kitchen-mart.com
Mail - Money Order or Cashiers Check