JFB Desktop Publishing

11550 S. Harlan Rd #30, Lathrop, CA, 95330-9730

Fax: 209) 983-0187, Voice (209) 983-0019

LaCie Order Form

Fill out this order form and print it. Mail or fax it to me . Keep a copy for your records.
We do not trust the web with credit cards. There is always the possibility a talented hacker can compromise you.

Name:

Address:


Ship to Above Address   Ship to Below Address

Ship To:


Payment Options: Mail with Cashier's Check
Mail with Personal Check ( wait for check to clear)
Pay by Credit Card


Credit Card:

 Visa
MasterCard
American Express
Discover

Card number : Expiration : Security code from back of card

Name on Credit Card:

Card Billing Address:

Home Phone with Area Code :

Day Phone with Area Code :
   Fax Number:

E-mail :


DESCRIPTION Part Number PRICE QTY TOTAL
$
$
$
$
$
$
$
$
Sub Total $
Ca Residents add sales tax Sales Tax $
U.S .Shipping ( $7.50 / item up to a total of $30.00)
International $20.00 and up Depending on weight and destination
$
TOTAL $

We thank you for your support.

Signature:_______________________________