Nursinguniformscrub ORDER FORM

Bill To: Ship To: (if different)
Company: Company:
Name: Name:
Address: Address:
City: City:
State & Zip Code: State
Phone: Zip Code:
Email: Phone:
Item Number Color Size Description Qty Price ea. Total
             
             
             
             
             
             
             
             
             
             
             

UPS Ground Shipping Charges
一般都走海运,空运价格另算

Sub Total:  
Shipping:  
Voice 1(678)464-3504 / FAX 1(678)393-2027 / www.Nursinguniformscrub.com
Total:  


METHOD OF PAYMENT

Check or money order payable to: AUTOMOTIVE WORKWEAR

If ordering by Credit Card, please fill in the information below:

VISA Master Card Discover American Express


MAIL TO:

America's Nursinguniformscrub
295 Laketrail Drive,
Alpharetta,
GA 30022,
USA.


CREDIT CARD NUMBER

EXPIRATION DATE

AMOUNT


CVV2 CODE
NAME AS IT APPEARS ON CARD


SIGNATURE DATE