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Please review your order and fill out the following shipping information. When finished, use the button at the bottom to send the order, or print the order and send via mail or fax to the address shown.

Description Price Amt. Item Total
Herb's Bogus Book 1 Paperback $5.25 1 $5.25
Sub Total $5.25
Texas Residents add 8% sales tax
Total

Please fill out the following information.
Full Name:
Email (required):
Address 1:
Address 2:
City: State/Province:
ZIP/Postal Code: Country:
Day Phone: Night Phone:
Please fill out your credit card information.
Card Type:
Card Number:
Expiration Date:
Signature:
(For fax/mail orders.)
Some Bogus Company
Some Bogus Address
Houston, TX 77254		 Fax (713) 666-6666
Voice (713) 777-7777
Email: bogus@bogus.bogus

To order by fax or phone, print this page with the requested information and send it to us. Orders are usually shipped the following day.

For purposes of testing, enter email address to send form to