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ED'S BOXCAR USA   

 FAX / MAIL ORDER FORM

When printing this form, print page 1 only

FAX to: 1 334 855 2084 

or mail to:

Ed's Boxcar

 Print form and fax or mail

128 Whitetail Rd

 

Seale , Alabama 36875

 

 

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Ship to address:    Phone number:          --          --

Name:

 

Address (1):

 

Address (2):

 

City:

 

State:

 

Zip Code:

 

 

 

Credit Card

Billing Address (if Different from Ship to)

Name:

 

Address (1):

 

Address (2):

 

City:

 

State:

 

Zip Code:

 

 

                    To use your credit card, you must include the C V V #

Credit Card Info:

Check one VISA 1    MasterCard 1 C V V # __________

CC Number:

 

CC Expiration Date:

 

Signature:

 

 

 

 

Catalog No:

Manufacturer:

Description:  (Add additional pages if necessary)

QTY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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