BrandName Electronics Order Form
Products
Coaxial Cable
3ft - $5
8ft - $10
14ft - $18
20ft - $22
50ft - $38
100ft - $50
MP3 Players
Tiny 2GB - $135
Tiny 4GB - $200
Tiny 8GB - $225
30GB - $225
50GB - $300
80GB - $350
Computer Assessories
2GB Flash drive - $40
100pk CD-R - $20
50pk DVD-R - $45
50pk DVD+R - $45
100pk DVD-R - $60
100pk DVD+R - $60
Glossy Printer Paper (50pgs) - $40
Shipping
*
Shipping Options
Overnight - $15
2 Day Delivery - $10
Standard Ground (5-7 Days) - $6
Billing Address
*
First Name
*
Last Name
*
Street Address
Address Line 2
*
City
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
*
Zip Code
*
Phone Number
*
Email Address
Coupon Code
*
Indicates Response Required