To order, please complete this order form.
This form does NOT automatically charge
your credit card (Impact Card) for your purchase when this form
is submitted. I will manually process your payment at the
time that I actually begin working on your order.
*FIRST and LAST Name:
*AF Base Name:
*MAILING Address Line 1:
Address Line 2:
order is needed by:
this order a Rush order?
Order Information .
piece count desired:
No, Do Not Magnetize my Puzzle
Yes, Magnetize the Puzzle(s). Price is $1.50 PER Puzzle Piece extra.
Credit Card Number:
V - Code:
Without this number, we can not process your order.
Card Expiration date:
The name exactly as
stated on the credit card: