COBRA CABLE
Online Order Form


Postal Address
COBRA CABLE
745 Burrage Rd.
Concord, NC
28025
USA 		Sales
Fax Number
704-795-2541
TOLL FREE
1-800-560-5313
Email
claudedill@aol.com

Customer Details


Name              
Email Address     
Organisation      
Homepage, if any  

Postal Address &
Phone No.

Purchase Details

PRODUCT
Item # Quantity Price Each ($US)
CC1 1-12 4.00
CC2 13-24 3.75
CC3 25-48 3.50
CC4 49-72 3.25
CC5 73 & Over Call
SHIPPING
Quantity Charges ($US)
1-6 3.00
7-13 4.00
14-24 5.00
25-48 6.00
49-72 7.00

Billing Details

Please type in the Number of Units, the Price Each and the Shipping Charges from the above tables. The Total Value will be automatically calculated.

QUANTITYPRICETOTAL
SUBTOTAL
NC Sales Tax 6.0%
Shipping
GRAND TOTAL

Credit Details

We Do NOT Accept Credit Cards at this Time. 


Method of payment
             Check via post
             Credit card via Fax
             Invoice me
             Credit card via online (fill details below)



Card Type
             Visa
             Mastercard
             American Express
Card Number 
Cardholder  
Expiry Date

Feedback


Comments
               
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