QualityShells.com Mail Order/Fax Form:

Please fill in all fields to insure a quickly processed shipment of your order.
Shipping Address:	Billing Address(address on credit card)
Name____________________________________	Name____________________________________
Address__________________________________	Address__________________________________
City_________________State_____Zip_________	City_________________State_____Zip_________
Country___________________________________	Country___________________________________
E-mail(optional)____________________________	E-mail(optional)____________________________
Phone Number_____________________________	Phone Number_____________________________
Fax number_______________________________	Fax number_______________________________
Today’s Date______________________________

Item Number	Description	Price	Quantity	Extension
To Find Your Shipping Charges:		Shipping Charge
Option #1 Follow the checkout procedure, shipping will be displayed before entering any credit card information.			Sales Tax (Florida Only)
Option #2  Call us for shipping charges.			Total
TYPE OF SHIPPING YOU CHOOSE:

Credit Card Type:_______________________________

Credit Card Number_____________________________

Expiration Date:___________

Mail orders to:  Quality Sales Co                  Fax orders to:  1-866-601-2678

                            616 17th St East - K

                            Palmetto, FL 34221

QualityShells.com toll free customer service phone number 1-800-216-1965