Fax Order Form

To: 802-419-4845

Name : __________________________________

Company : __________________________________

Address : __________________________________

City, State, Zip: _______________________________

Telephone: ____________________ ______________

Email : __________________________________

Name : ________________________________

Company : ________________________________

Address : ________________________________

City, State, Zip: _____________________________

Telephone: ________________________________

Email : ________________________________

Bill To: ( ) If same as shipping address

Ship To:

Item #	Description	Qty	Unit Price	Total
	* All Sale is Final. * Free Shipping promotions, Subject to Terms of Sale * Free Shipping Orders will be shipped via standard ground service only. * Free Shipping available to 48 contiguous states of the USA only.	Sub-Total
		Shipping
		Handling Chg.		$ 3.95
		Order Total

Thank you for shopping at www.kaccents.com

Order Details:
			COMPLETE DETAILS FOR CREDIT CARD PAYMENTS: Credit Card Type : Visa ( ) MasterCard ( ) Amex ( ) Credit Card No. : _____________________________ Cardholder Name : _____________________________ Expiration Date : _____________________________ CVV2 Number : _____________________________
	I confirm this order as detailed and agree to the terms of sale as posted on www.kaccents.com. I enclosed my check payment / I authorize Kaviik’s Accents to charge this order to my credit card given above. Customer / Cardholder Signature: ___________________________________ Date: ________________

CHECK & MONEY ORDER PAYMENTS

MAIL TO:

Accent Commerce Solutions

P.O. Box 802

Milltown, NJ 08850