phoenixtape.com                       Phone: 803-788-3184 - Fax: 803-736-0106 - Columbia, S.C.

SECURE - ON LINE ORDER FORM              WE ACCEPT VISA and MASTER CARD.
If you would like to place an order for any of our items please fill out the information below and click the submit button at the bottom of this form.  Please be sure to list your Email Address below.
Information shown in red are required fields. 
Your Name
Company Name
Mailing address
Shipping address
City
State Zip Code
Work Phone
Other Phone  
FAX
E-MAIL Please be sure to list your Email Address
BILLING INFORMATION
Credit card
Cardholder name

Card  number

Expiration date
   
Qty Item # DESCRIPTION Price Quoted
Importance Of  This Request
  PLEASE LIST ANY COMMENTS BELOW:
  
Note:  If you want a reply or confirmation by email, please list your email address in comment box or at the top where it ask for your email! 
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