OMS: Fax Order Sheet

OMS Fax Order Sheet

770 Magnolia Ave #1H
Corona, CA 92879

Print and Fax to 951-808-9952

Date:
Name:
Address:
City: State: Zip:
Phone:
Fax:
E-mail:

Date:
Name:
Address:
City:	State:	Zip:
Phone:
Fax:
E-mail:

Items Item Number Quantity

Unit Price X Quantity = Subtotal

Total (CA Residents please add 7.75% tax)
Shipping Options (All Orders shipped via Airborne Express)
Deadline 3 P.M. PT and No Sunday Delivery
(circle one) Ground (3-6 days) $10.95, 2-Day Express $14.50, Next Day by 3 pm $23.95
Shipping
Grand Total

Payment Information
Credit Card Number:
Exp. Card Type: Visa, MC, DIS, AMER
Name on Card:

Payment Information
Credit Card Number:
Exp.	Card Type: Visa, MC, DIS, AMER
Name on Card:

Thanks for your order! OMS

Any Questions, please call Toll-Free 877-678-4632.

Please Fax Back to 951-808-9952

Back to OMS Home Page

Items	Item Number	Quantity



Unit Price	X Quantity	= Subtotal



Total (CA Residents please add 7.75% tax)
Shipping Options (All Orders shipped via Airborne Express) Deadline 3 P.M. PT and No Sunday Delivery
(circle one) Ground (3-6 days) $10.95, 2-Day Express $14.50, Next Day by 3 pm $23.95
Shipping
Grand Total