Faxable Order Form From King Richard, LLC

You may type info into this form online or print & fill in the form off line. Select Print Then Fax Or Mail This Order form to the Number Or Address below.

Or Choose Our Secure Online Order form

Fax To 1-978-681-4163 / 24 HOUR SECURE FAX LINE Send E mail To : info@KingRichard.Net

CALL OUR ORDER LINE 978-687-9175 . $ 25.00 MINIMUM ORDER.

You may choose to mail this Order Form To Address Below

King Richard Co. P.O. Box 883 No. Andover, Ma 01845

NAME EMAIL

ADDRESS

CITYSTATEZIP

PHONE

CREDIT CARD ( Visa, MasterCard, Discover, Amex ) COD ADD $9.95

Credit Card #

EX DATE

Please Provide Credit Card 3 or 4 Digit Verification # Listed on back right of your Credit Card

Credit Card Billing Address

Check If same as above If not please list below

Name as it appears on your Credit Card

Billing Address

QTY	PRODUCT #	D I S C R I P T I O N	PRICE	TOTAL
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If you wish to order additional items please attach to this Fax

A SIGNATURE IS REQUIRED & WILL CONSTITUTE THIS AS YOUR AGREEMENT TO PAY TOTAL.	Sub Total
25 % Restocking & Service Charge On All Returned Items	Shipping
Delivery Time May Vary between 1- 4 weeks	Total
Most Orders will ship within 1-3 Days	Total
SIGNATURE_____________________________ Prices subject to change without notice Additional Shipping & Handling Fees May Apply on over sized orders or packages	Shipping Charges may be applied to this Total