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| 9436 RUSH STREET | 10323 HARRY HINES BLVD. | |
| SOUTH EL MONTE, CA 91733 | DALLAS, TX 75220 | |
| TEL: 626-228-0251 | TEL: 214-366-1328 | |
| FAX: 626-228-0253 | FAX: 214-956-8882 | |
| Maxtradesales@sbcglobal.net | Sales@Coolster.com |
Method of Payment |
| Dealer OR Customer |
| Name | Invoice No. | |
| Address | Date | |
| City,State,Zip | Sales Rep |
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| Fee Paid by credit card are subject to a convenience fee 3% of the total transaction amount incurred. |
Amount: |
$
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| 3% Conv. fee: |
$
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| Total: |
$
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Credit Card - Detail Information
| Company's name appears on the card | |
| Card holder's name appears on the card |
| Card #: |
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I want this order to be shipped or picked up byMAXTRADE |
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I am the card holder on this account and authorize the above amount to be charged by MAXTRADE. SIGN:Date: |
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Please sign and fax back this form to 626-228-0253 (L.A ) or 214-956-8882 (Dallas) | |
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