Secure Online Ordering

codemicro.com Secure Online
Order Form

Please complete the following form to place your order. For your convenience, we use the secure, real-time commerce services of

SELECT ITEM(S)

Fill in the item(s) below you would like to order. iTransact will calculate the form and confirm your order by email.
Item 1:
Description REF # Price $ Qty:

Item 2:
Description REF # Price $ Qty:

Item 3:
Description REF # Price $ Qty:

Item 4:
Description REF # Price $ Qty:

Item 5:
Description REF # Price $ Qty:

SELECT SHIPPING METHOD

UPS Ground ($ 8.95) space spaceInternational Orders: call 760-806-2731
UPS 3 Day Select ($ 15.95)space space afor shipping costs and options
UPS 2nd Day Air ($ 26.95)
UPS Next Day Air ($ 37.95)

YOUR INFORMATION

First Name: Last Name:

Address: Address has to match the address
on your credit card bill. A "SHIP TO" Name & Address (if different) may be entered on the next page.

City: State: Zip: use 5 digit zip only

Country:

Phone Number:

E-Mail Address:

First Name:	Last Name:
Address:	Address has to match the address on your credit card bill. A "SHIP TO" Name & Address (if different) may be entered on the next page.
City:	State: Zip: use 5 digit zip only
Country:
Phone Number:
E-Mail Address:

codemicro.com Secure Online Order Form

codemicro.com Secure Online
Order Form