Print this form, fill it out then mail it with your payment to:

Name:___________________________

Address:__________________________

City:________________State_______Zip______

Phone:(____)____-_____Ext____

Country:_________________________________

Ship To:

Item#

Description

Qty

Unit Price

Total

_____________________________________________________________________________________

_______________________

Item Total

California Residents    Please Add 8.0%

Packing & Shipping Fee

Grand Total

_______________________

_______________________

_______________________

C and Rs Wireless Accessories

            P.O. BOX 1015

          Ontario, CA 91762               

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Order Date: _____/_____/_____

Mailing Order Form

*Please make sure all information is correct before you mail in your order. Your payment must accompany your mail in order form  And must be                                            payable to: Cynthia Salazar         

Please provide the following information,

*Please Pay By:

             

            Check or Money Order

*Please allow 5-7 business days for checks to clear before your order to be processed. All Returned Checks are subject to a service charge of                                $25.00

$ 2.99