SpellSpot Fax Order Form
We DO NOT ACCEPT this form of payment for orders outside of the Continental USA
Please print out this form and fax it to our offices at (714) 633-4010.
You will receive a confirmation of receipt via email within 24 hours.
Customer Information
First Name*       
Last Name *       
Email      
Phone      
*Name must match information on credit card exactly
Credit Card Information
Card Type      
Card Number      
Expiration Date      

Card Verification Number (info see: http://www.dilos.com/ccv.html)

    
Shipping Address:
Address      
City      
State      
Zip Code      
Country      
Billing Address*:
*Must match credit card statement. Do not complete if same as Shipping Address
Address      
City      
State      
Zip Code      
Country      
Item(s) Ordered :   Price:
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
*Shipping Based on Order Total Total:   
$0.00 - $50.00 = $7.00 Shipping*  
$51.00 - $80.00 = $9.00  Grand Total:  
$81.00 - $100.00 = $12.00 
$101.00 - $300.00 = $13.00 
over $301.00 = $14.00 
Thank You for your order and Blessed Be!
~ SpellSpot.com