Nehaflix.com
560 Peoples Plaza, Suite 184, Newark, DE 19702-4798, USA. Fax: (734)-501-6785
|
FAX ORDER FORM |
| SHIPPING ADDRESS: | CREDIT CARD BILLING ADDRESS | ||||||
| Name: | Name: | ||||||
| Address: | Address: | ||||||
| City: | City: | ||||||
| State: | ZIP: | State: | ZIP: | ||||
| Country: | Country: | ||||||
| Phone: | Phone: | ||||||
| Credit Card: | |
| Card Number: | |
| Expiration Date: | |
| Email Address: | |
| Signature: |
| Full Description | QUANTITY | PRICE. | TOTAL. | |
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | ||||
| 7 | ||||
| 8 | ||||
| 9 | ||||
| 10 | ||||
| Shipping & Handling Charges (USA $5.00 Handling Charges per order, $1.00 per item) | ||||
| TOTAL | ||||
If paying by Cashiers Check, Check or Money Order, make it payable to Nehaflix.com and send payment to
address on the top of this form.
Thanks for ordering from Bollywood's Largest Online Store!