This is not an on-line form! Please print this form then fill out by hand. Thank you!

Novel Electronic Designs, Inc.
Credit Card Form

Instructions

1. Print and fill out this form.
2. Fax or mail the completed
    form with your order.

Fax: 309-274-8454

Novel Electronic Designs, Inc.
143 N. Third Street
Chillicothe, IL 61523-2156
 

Credit Card Type (circle one):  

 Visa      Master Card      Discover    AmEx
Credit Card Number:
Expiration Date: Security Code
(3 or 4 digit number on back of card):

Information about Card Holder
Name
 (as it appears on card)
Street:
City/State/ZIP:
Phone Number: 
where we can reach you if there's a problem processing your card
 

Cardholder's
 Signature:

Today's
Date:
 

Form Revised: 12 June 2011, Reviewed: 23 June 2011
Important:
1. Return Policy: notify immediately of intent to return, must be returned within 15 days.
    Customer is responsible for cost of return shipping. If customer refuses delivery of product,
    customer will be billed for actual costs charged by carrier to return product to us.
2. Shipping Fees (when present) are not refundable.
3. Custom-designed products are non-cancelable, non-returnable (unless stated otherwise on
    our quotation)

Thank you for your order!