Phone, Fax, or Mail Orders
.

Allview Mirrors Corporation
P.O. Box 92078
City of Industry, CA 91715
Toll Free:  1-866-200-8740
Fax:  626-968-6279 (24 hour)
e-mail: info@allviewmirror.com
 
 Please print out and complete this form.  Make check or money order payable to: Allview Mirrors Corp. US funds only.

 SOLD TO:		  
 SHIP TO: 
 Name: __________________________   [  ] Check here if same as Sold To
 Email: __________________________   Name: __________________________
 Address: __________________________  Address: __________________________
 City: __________________________  City __________________________
 State & Zip: __________________________  State & Zip: __________________________
 Nation: __________________________  Nation: __________________________
 Phone:

 

 (_____) _______________

 

  Phone:

 

 (_____) _______________

 

 Model No.
  Quantity
 Description
 Unit Price


Total Price
  1750

  _______

   ALLVIEW™ Mirror System  Model 1750   $ 59.95

$  _________
  1500

  _______

   Smart-Clip™ ALLVIEW™ Mirror System    $ 59.95

$  _________
  RAM
  _______
  Racers ALLVIEW™ Mirror (RAM™)
  $ 99.95
$  _________
  MKT
  _______
  ALLVIEW™ Mirror Mounting Kit
  $ 09.95
$  _________
Sub Total:

$  _________

California State Sales Tax (8.25%):
(applicable to all orders shipped to California)

$  _________

                             Shipping & handling ($ 9.95 per mirror US/$12.95 per mirror Canada/$4.05 per mounting kit):

$  _________
Total:

 

$  _________

 
 

 Method of Payment:

  

 [  ] VISA   [  ] MasterCard   [  ] AMEX   [  ] Discover 
 Credit Card Number:   _____________________________________
 Expiration Date: (mm/yyyy)  __________________ /__________________
 Name on Card:  _____________________________________
 Amount Charge to Card: $ ______________  Date:  _____________

 

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