wholesale jeans and apparel Order Form

Print this form, complete it with your order and fax it to Trans Am Wholesale at (915) 845-3939.
We accept Money Orders, Cashier Checks, Wire Transfers, Visa, MasterCard and Discover.
Or, pay at our secure on line store!

	Billing Information	Shipping Information
First Name:	______________________________	______________________________
Last Name:	______________________________	______________________________
Address 1:	______________________________	______________________________
Address 2:	______________________________	______________________________
City:	______________________________	______________________________
State:	______________________________	______________________________
Zip:	______________________________	______________________________
Day Phone:	______________________________	______________________________
Email:	______________________________	______________________________

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Payment Information: Credit Card Cashiers Check Money Order Wire Transfer
Credit Card Information: Complete only if paying by Credit Card. Max CC Order: $1,000
Name on Card:	_______________________	Credit Card Number:	_____________________
Card Type:	_______________________	Expiration Date:	_____________________
Card Verification #	________ (3 Digits)

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Product Name	Qty	Price/Pair	Ship/Pair
_______________________________________	____________	____________	____________
_______________________________________	____________	____________	____________
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