Order by Mail/Fax

How To Use This Ordering Feature

If you prefer to Fax your Order to us with your Credit Card as a Payment method, Please Fill the Below Form and Fax it to:

(713) 782-2763 Security Measure: All Faxes Upon Order Fulfillment are Shredded!

If you prefer to Order by Mail and Pay By Money Order/Cashiers Check/ Personal Check / Business Check, Please Print and Fill in the Below Form and Mail it with your Payment to:

WirelessGalaxy.com Inc.

Mail Orders Dept.

7100 Harwin Drive

Houston, TX 77036, USA

Toll Free # 1.800.569.8486

WirelessGalaxy.com Fast Mail/Fax Order Form

Item/Kit Name and Description if available

Phone Model

Advertised

Sale Price

Quantity

Total

Shipping & Handling Charges

FREE

$0.00

FREE

Total

Select Payment Method:

Check Appropriate Box R

Pay By Credit Card:

Credit Card Account Number: ______________________________

Credit Card Expiration Date: _____/ ____

(MM / YY)

Money Order/Cashiers Check/ Personal Check / Business Check (Enclose the Payment and Mail to Our Address Given at the Top of this Form)

Mail My Order to the Following Address:

Attention To:

Full Name: ____________________________________________________________

Email: ____________________________________________________________

Address: _______________________________________________________________________

City: ____________________________________________________________

State: ____________________________

ZipCode: ____________________________

Country: ____________________________

Work Phone Number: ( ) _____________________

Home Phone Number: ( ) _____________________

? Need Help Filling this Form, Please Call 1800-569-8486

Security Measure: All Faxes Upon Order Fulfillment are Shredded!

Document No: WGSK07082002