Trish Kaufmann Secure Order Form

Patricia A. Kaufmann

ORDER FORM

Personal Information

First Name *

Looks good!

Please enter First Name.

Last Name *

Looks good!

Please enter Last Name.

Email *

Looks good!

Please enter Email.

Phone *

Looks good!

Please enter Phone.

Billing Address

Address *

Looks good!

Please enter Street.

Address Line Two

City/Town *

Looks good!

Please enter City.

State/Province *

Looks good!

Please enter State.

Zip/Postal Code *

Looks good!

Please enter Zip Code.

Country *

Looks good!

Please select Country.

Shipping Address

Address *

Looks good!

Please enter Street.

Address Line Two

City/Town *

Looks good!

Please enter City.

State/Province *

Looks good!

Please enter State.

Zip/Postal Code *

Looks good!

Please enter Zip Code.

Country *

Looks good!

Please select Country.

Same for Shipping Address

Order Details

Order Date & Time

Price *

Looks good!

Please enter Price.

Price for item.

Item # *

Looks good!

Please enter Item#.

Brief Description *

Looks good!

Please enter Description.

Please give a brief description to ensure accuracy.

Price

Price for item.

Item #

Brief Description

Please give a brief description to ensure accuracy.

Price

Price for item.

Item #

Brief Description

Please give a brief description to ensure accuracy.

Price

Price for item.

Item #

Brief Description

Please give a brief description to ensure accuracy.

Price

Price for item.

Item #

Brief Description

Please give a brief description to ensure accuracy.

Membership & References

CWPS Member?

Yes

No

CWPS Member #

As a member you receive an instant 10% off your order.

APS Member #

USPCS Member #

References

If unknown to me and paying by check, please provide references: preferably a nationally known dealer or auction house. If references are not nationally known, please provide their contact information.

Sub-Total

CWPS 10% Discount Applied

Shipping & Handling *

Looks good!

Please enter Shipping.

See Ordering and Sales Polices. Please input appropiate shipping charge from Order Policies guidelines.

Total

Delaware has no sales tax.

Total Amount Due is

Payment Method

Credit/Debit

Pay Now with Card

This will open a payment popup to enter credit or debit card details.

Mail-In

Check or Money Order

I will send a check or money order

Paypal

Paypal Preferred

Please email me a PayPal invoice.

X

Terms & Conditions

Ordering and Sales Policies (Terms and Conditions of Sale)

I Agree to Terms and Conditions of Sale *

This checkbox must be checked to proceed.

When you click on "Submit Order," if you do not receive the order-received message, ensure that all required boxes (*) are filled out and try again. If it still does not go through, please email or call me. Trish Kaufmann

Form created by Digital Whale & Payment secured by Authorize.net