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		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:_______________________________