Order Form

Please take a print and complete the following information and FAX / Mail to:
East West International
5810 Hillcroft Ave. Houston, TX 77036
FAX No. - 713-789-6662

Name(As appears on the Credit Card)_______________________________________________________________

Telephone No. - Office:__________________ Home:______________________ Cell:_______________________

Card Type: Visa:______ MasterCard:______ Discover:______ American Express:______

Card No.:__________________________________________ Expiration Date:_________________

3 Digit CVV Code on back of the Credit Card:__________

Credit Card Issuer(Bank) Name & Phone no. ____________________________________________________________

I, ________________________________________________, authorize East West International to charge my credit card
for the purchase of the item(s) listed below.

Sr. No. Description
Quantity
Unite Price $
Total $
         
         
         
         
         
         
         

Shipping and Handling Charges $ ____________
Texas Residents add 8.25% Tax $ ____________
Grand Total for this order (USD)$ ____________

Billing Address: ______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Shipping Address: ___________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

TERMS AND CONDITIONS:

Sign here to confirm order _______________________________ Date: ________________________