EXPANSE GAMING

(www.ExpanseGaming.com)

P.O. BOX 24

BANCROFT, MI 48414

Phone (866) 450-6743

Fax (517) 625-1889

MAIL ORDER FORM

DATE:

Store use ORDER #

Ship To:

Bill To:

First Name

  

First Name

  

Last Name

  

Last Name

  

Phone #

  

Phone #

  

Address

  

Address

 


Address Line 2

  


Address Line 2

  

City, State Zip

  

City, State Zip

  

Country

  

Country

  

Email address

  

Email address

  

Shipping Information:  Choose shipping method and place amount below on the order form when figuring your total.

Payment Information:  Please choose your payment method. If Credit Card enter your information HERE.

UPS Ground   $7.00

Check - Money Order - Cashiers Check - Visa - Mastercard - Discover

UPS 3rd Day   $14.00

UPS 2nd Day   $18.00

CC#                                                             

Expire

UPS Next Day   $28.00

Signature

Code

Product

Quantity

Price/Ea.

Total
         
         
         
         
         
         
         
         
         
 

Shipping Method:

    

Michigan residents only add 6% Sales Tax

Sales Tax:

  
 

Total:

  

YOU MAY FAX THIS ORDER 24 HRS A DAY TO: 517-625-1889.  CALL TOLL FREE 866-450-6743 TO ORDER 9-5pm Eastern. Or Mail along with your payment to: Expanse Gaming P.O. Box 24 Bancroft, MI  48414.