Eagle International of
Longwood, Inc.
(407) 370-2929 · Fax (407) 370-2927 or 866-75-BEADS
email:
sales@beadwholesaler.com
NOTE: All domestic shipments are minimum $100
(all International shipments are minimum $200)
DATE:
Business
Name (If applicable):
YOUR
NAME:
FIRST TIME CUSTOMER (Yes, No):
EXISTING
CUSTOMER (Yes, No):
If Yes, Please give us your customer-id
or a previous invoice No (to speed up your order):
SHIPPING ADDRESS
Street
Address:
CITY:
State:
Zip:
Country:
Day-Time
Phone No.:
Fax
No. (if applicable):
E-Mail
address (in Block letters):
CREDIT
CARD INFORMATION
Credit Card Number:
Expiration date:
CVV2 (Security Code):
(3 digits on the back of VISA, MC, DISCOVER or 4 digits on front of AMEX)
Name on Card:
Signature of Credit Card Holder:
Address where Credit Card Bill comes to:
SHIPPING: (Mainland USA, Hawaii,
Puerto Rico, Alaska, USVI)
UPS
Ground___ 3rd
day___ 2nd day_ Next day air___
Priority Mail ___
Express Mail____
SHIPPING (International):
Priority Mail Int’l___ Express Mail Int’l____
Guaranteed Express Mail___ UPS_____
COMMENTS/SPECIAL INSTRUCTIONS
ORDER (Please enter in your order
below):
Item code Brief description Quantity PRICE