Fax Order Form - Chess Shop - 212-995-9192

Please fill out all information below. It is important that you include your phone and fax numbers in case we have to contact you regarding your order. You may also use this to order by mail. See Ordering Information for details.

To fax an order in use your browser's print function to print this form. The print function is usually found under the File... menu selection. If you cannot print out our form it's fine to create your own with all the pertinent information included.

Date:______________				(Write "Same" if same as ship to)

Shipping Address:				Billing Address: (For Credit Card)
						
Name:____________________________________	Name:_________________________________

Address:_________________________________	Address:______________________________

Address:_________________________________	Address:______________________________

City:____________________________________	City:_________________________________

State:________________ Zip:______________	State:_________________ Zip:__________

Phone Number:____________________________       

E-Mail:__________________________________	Fax Number:___________________________

Qty	Item #	Description		Color/Size	Price each	Extended Price

______	_______	_______________________	_______________	______________	______________

______	_______	_______________________	_______________	______________	______________

______	_______	_______________________	_______________	______________	______________

							Sub-Total	______________

							Shipping	______________

							Tax (8.375% NY)	______________

							Total		______________

Payment (circle one): Visa / MC / Amex / Disc

Card Number:_______________________________

Exp Date:__________________________________

Signature:_________________________________

Please Fax this form to 212-995-9192. Thank you for your order.