Shoppers World Marketplace

Mail in Layaway order form

Mail To:   Shoppers World Marketplace

               204 Laurel Ave.

               Arcadia, CA 91006

               Attn: LWP dept.

Phone: (213) 291-8328   or   Fax:   (213) 291-8780                     DATE:_______________    

                                                                                                                                     

Bill To:	Ship To:
Name	Name
Company	Company
Address	Address
City, State ZIP	City, State ZIP
Phone	Phone

 

Comments or Special Instructions:   If there are any special instructions please include them in the comment box.

 

Method of Payment: Personal Checks, Money Order  Debt/ Credit Card   VISA______ Master Card______ American Express______

 

Card Number   ____________________________     Exp. Date   ____________  (Month/Year)   

 

Code (3 #’s on back) ___________

                                                                                      

QUANTITY	DESCRIPTION	UNIT PRICE	AMOUNT
		SUBTOTAL
		CA. SALES TAX 8.75%
		SHIPPING & HANDLING
		TOTAL DUE

 

 

 

Make all money orders/Checks payable to:   Shoppers World Marketplace

 

If you have any questions, contact Customer Service at:  (213) 291-8328 or email us at customerservice@shoppersworldmarketplace.com

 

Would you like to have your monthly payments automatically paid through your debit or credit card?  __Y  __N

 

If Yes, what amount shall we deduct each month:  $______________

 

On what day of the month would you like to make this payment: _____________

 

THANK YOU FOR YOUR BUSINESS!

 

Comments: