A Simpler Time Order Fax Form (Fax number is 919-336-3157)

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A Simpler Time
118 International Drive, Suite 110
Morrisville, NC 27560
1-888-851-9088 (toll-free)
919-336-3154 (direct)
919-336-3157 (fax)
contact@asimplertime.com

Qty Name of Item Price of Item Personalization

(as seen on website) (as seen on website) (if applicable)

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Bill To: Ship To: (If same as Bill To, please write 'Same')

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Customer Info:

Telephone Number: ____________________________

Email Address: ________________________________

Credit Card Info:

Credit Card Type: _____________ Card #: _______________________________ Exp: _________

Name on Card: ___________________________ Security Code: _________

Your Signature: ___________________________________________________

Special Instructions: