G&Z Order Form

Please fill out the order form below, print and fax/mail it to us

E-mail Address*:
Company Name: Tax ID #:
Your Name*:
Billing Address:Street*:
City*:
State/Province*:Zip*:
Country*:
Phone*:

Fax:

(CHECK HERE if billing and shipping information are the same.)
Shipping address is for Business or Residential
Shipping Address:Street:
City:
State/Province:Zip:
Country:
Phone:

Fax:

Item #
Unit Price
Quantity
Unit Price x Qty

Use additional sheet if needed

-Shipping charges will be calculated after receiving your order-

Select the Shipping type:

Payment Type:



Master Card Visa AMEX Discover PayPal (paypal@gzintlinc.com)
Money Order/Checks (See below for mailing address)
Name on Card:
Credit Card Numbers:

*Issue Number(CVV code):

*(Last 3 digits of security code on the reverse of card / 4 digits for AMEX at the front)

Expiration Date:

(e.g. mm/yyyy)

Comments/Special requests:

_________________________________________Cardholder Signature*

(By singing above, you agree to the Cardholder Agreement and G&Z Terms & Conditions)

*If paying by check or money order, make payable to:

G&Z International, Inc.
11424 Chairman Dr., Dallas, TX 75243
Phone: (214)342-1900   Fax: (214)279-0020

Thank you for your business!

Copyright 2011 G&Z International, Inc.  All Rights Reserved.

Web Site: http://www.gzintlinc.com