CHI Machine Order Request Form

Please fill out this form to order your CHI Machine.
 If you have any specific questions or cemments, please enter them in the Comments section below. Thanks!

 
Important--All information provided is kept confidential. We never resell it or use it for any other purpose other than that for which it is intended.

 
Caution: this is an unsecure server.  While many sites employ an unsecure order server, if you are uncomfortable using it to send your credit card information, you can call 610-539-5666 and leave a message, fax it to 610-539-5512,  or send it in a separate email by clicking here.  We are sorry for this inconvenience.

NOTE--Fields marked with an asterisk ( * ) are required.

Name ( * ):

Street Address ( * ):

NOTE: UPS will not deliver to a Post Office Box.

City ( * ):

State ( * ):

County ( * ):

ZIP/Postal Code ( * ):

Country ( * ):

Telephone Number ( * ):

Email Address ( * ):

Quantity Desired at $480.00 USD each (plus applicable state sales tax), with shipping included! ( * ):

Credit Card Type ( * ):

Credit Card Number ( * ):

Name on Card ( * ):

Card Expiration Date ( * ): / 

Comments:

Thanks for your order!

Your CHI Machine will be delivered in approximately 10 - 14 days.


 

To Return to the JS Comm/Design Home Page Click HERE .


Copyright © 2001 by JS Comm/Design. All rights reserved.


Email Us