mooreordercgiformnew

Moore Mfg Order Form

This is a Secure Server order form for mooremfg.com .If you wish to order a Snow tube, use the Secure Snowtube order form. All orders are sent through a certified secure server at our web host zipcon. Secure services are based on a Thawte certificate. The form results are transmitted using the Secure Socket Layer (SSL).

"Our secure web pages are being hosted by Zipcon, who use a Thawte SSL Certificate to ensure secure transmission of your information."

Please provide the following contact, billing, and shipping information:
ORDERED BY:
Note: * indicates a required field

First name*

Last name*

Street address*

Address (cont.)

City*

State/Province*

Zip/Postal code* Plus 4

Country

Check this if shipping is to a Gov't or business address

Work Phone

Home Phone*

E-mail*

Please provide the following product information:

	RADIO HARNESS
Order other items not in the drop down list, specify sizes, or color information in the boxes below:

Send us a note, color, special shipping instructions or additional order information in this comment box:

SHIPPING

Exact shipping costs are added to each order, based on weights as shown below. Snow Tubes are shipped UPS, and Radio Harnesses are shipped USPS, and UPS based on quantity. If you wish an estimate of UPS costs, follow this link, the originating zip code is 98288.

BILLING

Credit card* Expiration date:

Cardholder name*

Card number*

3 number security code*
This is required for business, school, or government purchasing cards, we cannot process the order without it.You can find your 3 digit (4 digit for some AMEX cards) security/customer code on the back of your credit card after your last 4 credit card numbers.

Purchase Order #

Business, school, or gov't agency name

Purchasing Agent/Buyer name

SHIP TO (if different from ordered by):

First name

Last name

Street address

Address (cont.)

City

State/Province

Zip/Postal code Plus 4

Check this if shipping is to a Gov't or business address

Country

This is a secure server order form for Moore Mfg Co, and Snowtubes.com. It is an easy, secure way to send credit card information and place orders. Feel free to type us a note if you need to give us more information. This is NOT a shopping cart, so order totals, shipping costs, and order confirmation numbers will NOT appear. We will e-mail you as soon as we get your secure order to confirm quantity, colors in stock and shipping preferences. We check our secure orders every 2 hours.

First name*
Last name*
Street address*
Address (cont.)
City*
State/Province*
Zip/Postal code*	Plus 4
Country
	Check this if shipping is to a Gov't or business address
Work Phone
Home Phone*
E-mail*

BILLING
Credit card*	Expiration date:
Cardholder name*
Card number*
3 number security code*	This is *required* for business, school, or government purchasing cards, we cannot process the order without it.You can find your 3 digit (4 digit for some AMEX cards) security/customer code on the back of your credit card after your last 4 credit card numbers.
Purchase Order #
Business, school, or gov't agency name
Purchasing Agent/Buyer name

SHIP TO (if different from ordered by):
First name
Last name
Street address
Address (cont.)
City
State/Province
Zip/Postal code	Plus 4
	Check this if shipping is to a Gov't or business address
Country

Moore Mfg Order Form

© Moore Manufacturing 2010