X-Chrom: Fax & Mail Orders

X-Chrom * x-chrom.com

fax & mail orders

This form is for fax and mail orders only!

Do not attempt to complete this form online - it won't work! If you would like to order securely online, please go to our shopping cart area.

Ordering Instructions:

1. Print out this form from your computer.

2. Fill it out completely, printing clearly.

3. Mail the form, with your check or money order payable to X-Chrom, to:

X-Chrom.com
7181 W. Grand Avenue
Chicago, IL 60707

or, fax it to: 1-773-385-9558.

Billing Information

Name:
Address:
Address cont.
City:
State:
Zip Code:
Daytime Phone:
Evening Phone:
Email Address:

Shipping Information
(if different from Billing Information above)

Name:
Address:
Address cont.
City:
State:
Zip Code:

Payment Method

Visa Mastercard AmEx
Credit card number:
Expiration Date: /

Signature of card holder:

Check or money order payable to X-Chrom

Item Number	Description	Size	1st Color Choice	Alt. Color	Qty	Price	Total

Sub-total:

Shipping & Handling *
(standard US Post service)

Sub-total: Add:

$0 - 29.99 $4.95

$30.00 - 89.99 $5.95

$90.00 - 149.99 $6.95

$150.00 - 199.99 $7.95

$200.00 and up $8.95

Grand total:

*24 hour shipping on in-stock items!

Please note:

* International orders to ship airmail (7-10 days) will cost the same as any US order shipping US Post unless otherwise notified by email
* International orders to ship faster than airmail, contact us for shipping rates
* Add $15.00 to the cost of your order's standard shipping service for overnight US shipping service
* Add $10.00 to the cost of your order's standard shipping service for 2-day air US shipping service
* US orders shipping to Illinois must add sales tax to the order total. Multiply the total cost of the merchandise by 9% (0.09) to calculate sales tax due and add this to your order's total.

*Please allow 7-10 working days for processing check orders.

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