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Tuesday, February 23, 2010
Order Your Couponizer ;)
Billing Information ~ print this out for your records!!!!
First Name:_______________________________________
Last Name:_______________________________________
Last Name:_______________________________________
Phone:____________________________________________
Email:_____________________________________________
Address:_________________________________________
Address 2:______________________________________
City:______________________________________________
Zip:______________________________________________
State:___________________________________________
The website Subtotal: $19.95
& Shipping: $5.75
Online Total: $25.70
Payment Method: Check: Cash: Paypal: Other: Date:
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