Sockpro Offline Ordering

Shipping Information
Name	_______________________________________________
Street Address	_______________________________________________
City, State, Zip	_______________________________________________
Telephone Number	_______________________________________________
Email Address	_______________________________________________
Billing Information
SAME AS ABOVE	____Check here
Name	_______________________________________________
Address	_______________________________________________
City, State, Zip	_______________________________________________
Telephone Number	_______________________________________________
Email Address	_______________________________________________
Method of Payment
Check Enclosed	_______
Credit Card Number_____________________________________ Expiration Date _______ CVD #____ (CVD# is the last three numbers located on the back of your credit card above the signature, and for AMX on the front right side above the card number.)



Item	Color		Quantity	Price Each	Total

Single Pack	Blue		______	$4.99
	Black		______
	Red		______
	White		______
	Yellow		______
					_____________


Three Pack	Yellow/White/Blue		______	$14.97
	Yellow/Black/Red		______		_____________

Four Pack	Black/White/Blue/Yellow		______	$19.96
	Black/Yellow/Blue/Red		______		_____________

Five Pack	Blue/Red/Yellow/Black/White		______	$24.95	_____________


Shipping Charges Based on Total Sales Amount			SubTotal		_____________
	00.00-10.00	2.50
	10.00 +	FREE	Tax (Wisconsin Only) 5.1%		_____________

			Shipping		_____________

			Total Billing Amount		_____________