Om Imports - Order Form

Please print this page and FAX 310-538-2090* or Mail it to:*
Om Imports, Inc. 17510 S. Broadway, Suite A, Gardena, CA 90248 Phone: (310) 538-2200 * (800) 858-8677 * FAX: (310) 538-2090
Order Form - (Minimum Order: $100.00) All orders from within California will be added 9.25% sales tax unless you provide RESALE INFORMATION.		Date____________________
Company Name______________________________________________________ Address_____________________________________________________________ City___________________________________ State_________ Zip____________ Contact Person_______________________________________________________ Phone_____________________________ FAX_____________________________ E-Mail_______________________________________________________________	Payment Options: ______COD Money Order/Cashier Check ______ Credit Card	Shipping Options: ______ UPS Next Day Air ______ UPS 2nd Day Air ______ UPS 3 Day Select ______ UPS Ground

Signature____________________________________________
Thank you for your order.

ITEM NUMBER	QUANTITY	DESCRIPTION	UNIT PRICE	EXTENDED PRICE



















Credit Card Information ___ MasterCard ___ Visa ___ American Express ___ Discover Name __________________________________________ CC# ________-________-________-________ Exp. Date _____/_____ Credit Card Billing Address_______________________________________ __________________________________________________________			SUBTOTAL
			SHIPPING	shipping charges will be determine once order is ready to ship
			TOTAL