Fax/Mail Manual Order Form
Billing Info
Name: _______________________________Company:_____________________________________
Address:________________________________City:________________ St:___ Zip:_________
Telephone#: ________________ Fax#: _________________ Email: ______________________
Shipping Info ___ Check if same as Billing
Name: _______________________________Company:_____________________________________
Address:________________________________City:________________ St:___ Zip:_________
Telephone#: ________________ Fax#: _________________ Email: ______________________
Order Information
DESCRIPTION QTY. PRICE
1._______________________________________________________________ _______ ________
2._______________________________________________________________ _______ ________
3._______________________________________________________________ _______ ________
Before we place this order, we will call (or email) with the
total including the exact shipping cost.
Indicate Payment Method with an "X":
__ Purchase order:_____________________________
__ Check or money order. Checks must be US bank checks.
__ VISA __ MasterCard __ Discover __ American Express
Name as it is on card _____________________________________________________
Card #: __________________ Expire MM/YY: _______ 3 or 4 Digit Card ID: _____
Signature as it is on card: ________________________________________________
Make check out and mail this order form to following address,
or fax toll free to 866-827-7747:
Bright Hospitality Inc.
P.O. Box 374,
Titusville, PA 16354