Mail Order Form

Print this page, fill it out completely and mail to:
801 E. Orchard
Mundelein, IL 60060

Please include either a check made payable to Shop Online, Inc. or your credit card information.

Item# Description Price Qty Total
Sales Tax 7% Illinois Res. Only
Shipping & Handling


Keycode: ____________


Personal Information

Name: ____________________________________

Address: ____________________________________



Zip: __________________

Phone Number:(____________)_______________________

Email Address: ____________________________________


Payment Method (please check one)

_____ Visa

_____ MasterCard

_____ Discover

_____ Check

Credit Card Number ________________________________________________________________

Expiration Date ______________

CVV2 # __________________

How would you like to be contacted? _________________________________________