Phone Order

Phone Order:	Tel: (671)-632-3366
Fax Order:	Print out this form and Fax to : (671)-632-0307
Mail order:	Mail your Personal check or Money Order to:
	Worldwide Factory Direct
	15904 Lake Hill Blvd
	Bellevue WA 98008

Item #	Quantity	Description / Color	Unit Price	Sub Total






Shipping & Handling US $4.00 per item (via US Postal Service / UPS) International $7.00 per item (via first class air mail)
Grand Total

Payment Information
(for cashier's check or money order, please fill out "Shipping Address" and "email address" field only)

Card Holder's Name
Card Type
Card Number		Exp.Date :
Issuer Bank
Billing Address
City:
Zip Code:		Country :
Phone Number
Email Address
Shipping Address (if different from Billing address)
		City:
Zip Code:		Country :
Signature:
Date: