SHIPPING INFO
BILLING INFO (fill in only if different)
Name____________________Name____________________
Address____________________Address____________________
Address____________________Address____________________
City____________________City____________________
State____________________State____________________
Zip____________________Zip____________________
Phone____________________Phone____________________
Email____________________Email____________________
CREDIT CARD INFO (if not paying by check or money order)
We accept credit cards, checks and money orders from the US, including APO/FPO's. We accept credit cards and international money orders from Puerto Rico. We do not accept orders from any other countries.
Card #____________________Exp.____________________
Name on Card____________________TypeVisa Mastercard Amex (circle one)
CSC Code____________________What is a CSC Code? Visa/MC | Amex
Standard Ground Shipping
Order Total Shipping Cost
$0.01-$19.99 $10.00
$20.00-$49.99 $12.00
$50.00 and up $14.00
More shipping options for AK, HI, Puerto Rico, Economy & Express shipping: See Chart
PURCHASE INFO
Product CodeDescription Size/Color (if applicable)QtyPrice Ea.Total
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
_________________________________________$_______$______
  Subtotal$______
Shipping Method_______________________________Shipping$______
  GRAND TOTAL$______

If there is not enough room on this form attach your own paper or use two forms.
Mail this completed form to: Wild Syde 375 Faraday Ave. Jackson, NJ 08527
or you can FAX it 24/7 to: 732.557.6393