WIDGIT ORDER FORM

Number of Widgits
Selection (Please choose A - I, click on box to change options)

Price:
Tax if Applicable:
Shipping & Handling - actual shipping cost charged. For an additional $6.00 we will include special insulated Widgit packaging and an ice pack to protect meltdown of Widgits. Please check the appropriate box below:
Total

Type of Credit Card (click to change selection)
Credit Card Number:
If you would prefer, credit card orders/information may be called in at (607) 555-1212.
Credit Card Expiration Date:

Your name:
(E-mail address, essential to process forms)
Mailing address to send the package to:
Name:
Street:
Apartment/other:
City:
State:
Zip code:
Country:

We welcome any comment you may have regarding your order. Please feel free to use the space below to send us any comments or questions you have.