To submit an order, please print this form and fax it or mail it to:
Beer Designs
PO BOX 7013
Ventura, CA 93006
Please allow 1 week for shipping.
Items Ordered:
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Item Number
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Item Title
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Size
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Color
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Quantity
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Price
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Plus 7.25% sales tax (CA residents only)
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Shipping/Handling
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Total
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For more items, please print and include a second form.
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Customer Information
*First Name ________________________
*Last Name ________________________
Company ________________________
*Email ________________________
Phone _________________________
Credit Card Information
*Card Type ________________________
*Cardholder’s Name As Shown On Card ___________________________________
*Card Number ______________________
*Expiration Date (mmyy) ____ / ____
*3 Digit Security Code _______________
*Required fields.
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Billing Address
*Address Line 1 ______________________
*City _______________________________
*State/Province _______________________
*Country _____________________________
*Zip/Postal Code ______________________
Shipping Address (if different from billing address)
Ship To Name __________________________
Address Line 1 __________________________
City __________________________________
State/Province __________________________
Country _______________________________
Zip/Postal Code _________________________
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Thank you for ordering from Beer Designs. If you have any questions, please do not hesitate to contact us by phone at 866.550.BEER (2337) or fax us at 805.659.7185, or email to: sales@beeravenue.com.
