Cybertzara's BLACKMETAL.COM Text-Only Order Form
FAX TO: (520) 421-1208 * or PayPal to: eldenm@cox.net
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CHECKS & MOs PAYABLE T0: Cybertzara
Send to:
Cybertzara (BLACKMETAL.COM)
PO Box 12635
Casa Grande AZ 85230-2635 USA
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See ORDERING INFORMATION at the BLACKMETAL F.A.Q. and check our SHIPPING RATES for more details on shipping charges. We accept checks and money orders payable to CYBERTZARA. You may send well-hidden cash, but be aware that we are not responsible for cash that is stolen or lost in the mail.
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To order, please fill out this order form - PRINT CLEARLY:

Online Order Number: ________________ Email address :__________________________
Your Name: _____________________________________
SHIPPING ADDRESS: _______________________________ Apt/Suite #: _____________
City: ________________ State: ____ Zip(or Postal Code): __________ Country: _________________

Telephone number (IMPORTANT): __________________________
Please List the Items You Would Like To Order:
Item 1 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 2 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 3 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 4 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 5 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 6 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 7 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______
Item 8 _____________________________ FORMAT ______ QTY ____ Unit Price ______ Price ______

Please list several altern ate selections:

ALT 1 ______________________________ FORMAT ______ Price __________
ALT 2 ______________________________ FORMAT ______ Price __________
ALT 3 ______________________________ FORMAT ______ Price __________
ALT 4 ______________________________ FORMAT ______ Price __________

Sub-total __________________

(IMPORTANT: prices are NOT postage-paid. If you don't add appropriate shipping charges, your order WILL BE DELAYED! Please see the ORDERING INFORMATION at: http://www.blackmetal.com/cgi-bin/gold/category.cgi?category=shipping)

Applicable shipping charges: $____________
Arizona residents add 8.6% sales tax $____________
TOTAL FOR THIS ORDER $_____________

Payment Method (check one): ( ) Check ( ) Money Order ( ) Cash ( ) Pay Pal (see instructions here) If paying by credit card - CREDIT CARD Type (choose): ( ) MasterCard ( ) Visa ( ) American Express ( ) Discover ( ) JCB Card

Card No: ___________________ ________ Expiration Date (mm/yr): ____/____ CVV#: _____
Name Appearing on Card (print clearly): __________________________

Please allow 1-2 weeks for credit card orders. Order will be shipped upon receipt of payment - please allow 3 weeks for orders paid by personal check for bank clearance. By SUBMITTING this order form to Cybertzara, you hereby state that the above credit card information is correct and that you are the valid credit card holder.

Signature (REQUIRED for credit card orders):

X_________________________________________________
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