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


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

Fax: 800-406-8569

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

(as it appears on card)
Phone Number: 
where we can reach you if there's a problem processing your card




Form Revised: 20 Nov 2018, Reviewed: 02 January 2020

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.   
    Returns of orders will be charged a restock fee (15%, maximum).

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!