San Jose Candle Co.
Fax Order Form
Fax # (209) 984-1773

Name  
Organization   Phone #   Fax #  
Address  
City   State   Zip  
If you billing address is the same check box      
Address  
City   State   Zip  
 
Item # Description Qty Price
       
       
       
       
       
       
       
       
       
       
       

Credit Card Information

Type of Card Master Card    VISA         Discover Card 
Name on Card  
Card Number  
Expiration Date   CVC  
  This is the number on the back of the card
I would like someone to contact me about shipping charges before shipping candles
Just add any shipping charges and ship the candles UPS GROUND