TEMPLATE: Billing Information

Note: Your personal information will not be used in any way without your consent.

Please enter your first name into the field provided

Billing Address:	(* - required information)
*First name
*Last name
*Address 1
Address 2
*City
*State/Province
*Zip/Post Code
*Daytime Phone (xxx-xxx-xxxx)
*Email
	Check this box if the shipping Address is the same as your billing Address
Credit Card:	(* - required information)
*Card Type
*Card Number
*Expiration
Source Code:
Source Code
	(If you have a catalog, you will find the source code in the pink box on the back)
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