OutpostFlags Order Form

	Billing Information (Where you get your bank or credit card statements)
Name:
Address:

City:
State:
Zip:
Other:
Country:
E-Mail:
Phone:

	Shipping Information (If different than billing)
Name:
Address:

City:
State:
Zip:
Other:
Country:

Auction Site:
(If you are paying for items won or purchased through one of our auctions, please let us know the name of the auction site)

Have you ever placed an order with us before?

Yes

	Item Number	Enter the items you are ordering below. Please be sure to include additional information such as ring size, hat size, or clothing size or other information such as colors,stone,type....etc...	Quantity	Price Per Item	Total Price
Item1:
Item2:
Item3:
Item4:
Item5:
Item6:
Item7:
Item8:
Item9:
Item10:
	Enter Any Additional Items:	Item Number - Price - Description - Quantity		Total Price of all Additional Items:
				Total Amount:
		Shipping to USA (with tracking) is the base price of $8.95 for the first item. No additional shipping charge if total weight is less than than 1 pound. Add $2.95 for each additional item if total weight exceeds 1 pound. Shipping is $11.95 for large, long, or heavy objects. Customers from outside USA must pay a minimum of $25.00 for shipping WITH TRACKING unless they agree to NO TRACKING. For heavy, or large orders please contact us for a shipping quote. Please enter the shipping total.		Shipping Total:
		Wisconsin Residents Add 5.5% Sales Tax (Non-Wisconsin residents leave this field blank)		Wisconsin 5.5% Sales Tax:
		Please add the total amount, shipping price, and tax..		Total Price:

		Payment Information
		Please select ONE payment option.
		Master Card
		Visa
		Discover
		American Express
		Diners Club (Through Paypal)

		(When you complete this form, please submit it, regardless of what payment option you have chosen.


		E-Check (Fill out form below)
		Money Order or Check By Mail
		Phone In Order Toll Free (877) 521-9991 9am - 9pm USA Central Time (Please submit this form also)

Credit Card Information

Fill this out only if you are paying with a credit card. If you dont want to submit your credit card information online, please feel free to call in your credit card information.

Card Number:

Expiration Date:

CCV Code:

(If you don't know what the CCV Code is please see the picture on right)

E-Check Information

Name on Check:
Account Type:
Check Number:
Bank Routing Number:
Account Number:
Bank Name:
Bank State:
Drivers License Number:
Drivers License State:

Fill this section out only if you are paying with an E-Check. If you don't want to submit your check information online, please feel free to call us with it. After you have submitted your E-Check information to us, please void the check number.

Type Any Additional Comments or Questions Here.
How did you find us?

Please review our terms, and then check your information carefully. Click the submit button when you are finished.