Incode Order Form

Circle your choice of shipping method
Call 888-272-9951 or 9519-272-9951 for shipping & handling cost

Purchase Order #_______________________
(upon credit approval)

Prepayment by:

Company Check
Money Order
Cashier Check

C.O.D
$7 fee

Bank Wire Transfer
(call for bank info)

Western Union
(No Quick Collect)

Circle your choice of payment
NOTE: Purchase Orders must be faxed in to process order 951-270-0937

Incode Corp. Plastic Card Products & Services
12140 Severn Way, Riverside, CA 92503
Toll Free (888) 272-9951* Int'l (951) 272-9951 * FAX (951) 270-0937

NAME
COMPANY
SHIP TO:
Street Address, Suite # (no P.O. Box addresses)
City, State, Zip Code
Country

BILL ADDRESS:
Street Address or P.O. Box
City, State, Zip Code
Country

PHONE/FAX #
EMAIL

ITEM #	PRODUCT DESCRIPTION	QTY	PRICE	TOTAL















	SubTotal			_______
	Sales Taxes 7.75% (only California orders)			_______
	Shipping & Handling			_______
	TOTAL