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:
*E-mail:
*AF Base Name:
*MAILING Address Line 1:
Address Line 2:
*City:
*Phone:
*Date your order is needed by:
*Is this order a Rush order? Rush Order Information .
*Puzzle piece count desired:
*Puzzle Price:
*Magnetic?
No, Do Not Magnetize my Puzzle Yes, Magnetize the Puzzle(s). Price is $1.50 PER Puzzle Piece extra.
*Form of Payment:
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:
*Comments:
Mark,