Classic Goggles Fax or Mail in Order Form
Please type in personal info and order specifications, then print and send via Fax or Mail.

Fax: 815 642 4199 Mail: Classic Goggles, Inc. | P.O. Box 126 | Sparrow Bush, NY 12780
Bill To:
Name (as shown on credit card)
Address/Company
Address Apt/Suite
City State Zip Code
   
Ship To: (if different)
Name (as shown on credit card)
Address/Company
Address Apt/Suite
City State Zip Code
   
Contact Information:
Daytime Phone Number     E-Mail address
   
   
  Item # Description Size/Color Quantity Price Total
1.
2.
3.
4.
5.
Merchandise Total: 
New York State Residents Add 8.25% sales tax Tax: 
SubTotal: 
View Shipping Charges Shipping: 
TOTAL: 
   
Payment Information:
   
Payment Method (Check only one)
  Check   Money Order   Make all payments to "Classic Goggles, Inc."
  Discover/Novus   Visa   MasterCard   American Express
   
Credit Card Number     Credit Card Exp. Date
   
   
   
Signature: _____________________________________________________________________