Secured Order Form



SECURE ORDER FORM

SILESIA GROUP INC.,

P.O. BOX 350,

OAK LAWN, IL 60454, USA.




YOU CAN FAX YOUR ORDER TO : 1-773-767-7708, 1-800-6000-461





















Name:







Address:







City:







State:





Zip:







Phone:







E-mail:







 



Item No.

Qty.

Unit Price

Total




























































regular mail - SHIPPING & HANDLING - USA - $4.00

ORDERS ABOVE $40.00 PLEASE ADD 10%





PLEASE ALLOW ONE WEEK FOR DELIVERY



Grand Total:












Payment Information:



Money
Order

American Express

VISA

Mastercard

CC Number (Please
list all digits from your charge card)



Expiration
Date:























THANK YOU FOR YOUR ORDER

























Copyright (c) 1990
Silesia Group Inc. All rights reserved.
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