Please Print Out This Form, Complete It, And Fax It To Columbia Design at 888-750-6935

Pen/Pencil Order Form (Adobe Acrobat Version- Click Here)

Sold To: (Credit Card Address)

Name:

Day Time Phone:

Fax Number:

Last:  First:  MI

(  )

(  )

Street:

City: State: Zip:

E-mail Address:

Shipping Information (We do not ship to P.O. Boxes):

Company:

Attn:

Street:

City: State: Zip:

Item Code	Qty	Description	Price Each	Total ($)

Shipping Charges: We ship normally by United Parcel Service or FedEx. Call 888-240-4763, or email us, for current shipping rates, or leave cost blank and we will notify you of the cost before putting order into production. Please specify "Ground", 3 Day Select", "2nd Day Air", or "Overnight", etc. at right, next to "Total Shipping". BIC and PILOT orders ship from Florida.

Total From Above  $  Extra Charges (2nd or 3rd Imprint Color, Engraving, etc.)  $  Total Shipping  $  Sub Total (Add above lines)  $  Add 5.0% BIC State Service Chg. (CA; FL; MD; TN & WI. BIC Orders Only)  $ Add 8.25% Sales Tax (Texas Shipments Only)  $  TOTAL AMOUNT  $

Payment Method (Check One):

Payment Enclosed. Mail To: Columbia Design, 162 Navigator Crossing, Spring Branch, TX 78070

PayPal

Government Purchase Order. Fax signed purchase order.

American Express

VISA

MasterCard

Discover/Novus

Credit Card Information:

Acct. #

Exp. Date:

Signature (required for credit card orders):

Barrel/Trim Colors:  Point/Ink Color:

Imprint Instructions: (Imprint color(s) & copy):