Name:___________________________

Address:__________________________

City:________________State_______Zip______

Phone:(____)____-_____Ext____

E-Mail:_________________________________

Bill To:

Item#

Description

Qty

Unit Price

Total

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_______________________

Item Total

California Residents Please Add 8.0%

Packing & Shipping Fee

Grand Total

_______________________

_______________________

_______________________

                                      Fax Order Form

                           CandRs Wireless Accessories

                                         P.O. BOX 1015

                                      Ontario, CA 91762

        FAX  1(909) 218-4217 (# Is For Fax Only, Thank you!)

            Website: www.candrswirelessaccessories.com

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Order Date: _____/_____/_____

Charge To:

(as printed on card)

Print Order Form, Fill In, Then FAX ...

Signature__________________________

Ship To:

Name:___________________________

Address:__________________________

City:________________State_______Zip______

Name:___________________________

Visa __  M/C __ Discover __ Amex __

Card # _____-_____-_____-_____

Exp. Date ____/____ Zip Code______

Verification#:___________

(Last 3 digits on back of card, 4-digit on front for AMEX)

$2.99