Order Form

Don't have a credit or debit card ? Write us an E-Check, or just print out the form and and mail a check or money order.

Don't like submitting your credit card over the internet ? Submit this form with your order, and call us with your information. We will also accept Paypal (outpostflags@cybrzn.com), Alert Pay, Money Bookers, and Western Union.

Outpost Flags
Box 343
Goodman, WI 54125
USA

9:00 am to 9:00 pm Central time
Visa, Master Card, Discover, American Express, Diners, JCB, PayPal (outpostflags@cybrzn.com), Alert Pay, Money Bookers, Western Union, E-Checks, Credit or Debit.
1 (877) 356-1067

Toll Free: (877) 521-9991

9:00 am to 9:00 pm USA Central time

Toll Free: (877) 521-9991

9:00 am to 9:00 pm USA Central time

	Billing Information (Where you get your bank and/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:

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 is the base price of $7.95 for the first item and $2.95 for each additional item. Shipping is $11.95 for large or heavy objects. Customers from outside North America please contact us for a shipping quote. Please enter the shipping total.		Shipping Total:
		Wisconsin Residents Add 5.5% Sales Tax		Wisconsin 5.5% Sales Tax:
		Please add the total amount and shipping price together.		Total Price:

		Payment Information
		Please select ONE payment option.
		Master Card
		Visa
		Discover
		American Express
		JCB (Temporarily Un-Available)

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

		Diners (Temporarily Un-Available)
		Paypal (After you submit this form, please make a Paypal payment to: outpostflags@cybrzn.com)
		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

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 your information carefully and click the submit button when you are finished.

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