Item3: Qty SKU Price$
You need your items: Overnight, 2days, 3days, 4-7days, 8-20days
Shipping $, Reference Number , Total $
Pricing fields may be left blank as actual item and shipping charges will be calculated and added to your order accordingly.
2. Payment Information
Mastercard, VISA, Card Number Expiration
Name of bank or credit union that issued the card
Cardholder's name as appears on the card
Cardholder's Telephone Signature:
Cardholder's Billing Address (Street / City / State / ZIP)
Billing charges will appear on your statement as ''MENDAX MICRO 1-800-963-6329"
3.Provide us with your Contact Information
Web Site http://
Shipping Address, if different that billing address (Street / City / State / ZIP)
<We ship only to credit card billing address. If different ship address is required, please contact us.>
4. Fax this information to our secure faxserver
If you can send a fax directly from your computer: go to File, Print, and then choose the correct printer driver, and then fax us this completed form to (514)620-2093.
If you cannot send faxes straight from your computer, print out this web form to your printer, include your signature, an fax it to (514)620-2093.
When you send fax to us, you are getting a dedicated fax-to-pc telco connection directly to our secure faxserver. You will receive a confirmation by email, it will also include the order's exact total that was billed to your credit card.