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To submit this order via email, please copy and paste this page in an email to eesales@HardwareExpedited.com.
DO NOT E-MAIL YOUR CREDIT CARD INFORMATION.
We will call you for that information. * * * OR * * * Print and fax it  to (541) 727-5363.
Billing Information - must match the credit card statement
**Required Information
Credit Card Number:
Credit Card Expiration (mm/yyyy): American Express Visa MasterCard Discover Card
Card Verification Number: Card Verification Number
4 digits - AMEX front, 3 digits - Visa, MC, Disc back
**Name (as it appears on card):
**Billing Address (of the card):
Billing Address #2:
**City:
**State:
**Country:
**Postal Zip Code:
**Daytime Telephone:
**E-Mail Address:
Please provide any additional information required for your order (ie: Split finish, Door Thickness greater than 1-3/4", etc):
*
Shipping Information - must include a street address (NO PO/APO boxes)
**Shipping Street Address:
Shipping Address #2:
**City:
**State:
**Country:
**Postal Zip Code:
You may print this form and fax it to (541) 727-5363.

Please review our Return / Exchange Policy prior to placing your order.


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