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Please fill out the following info below to complete your order - also sign-up for www.1dollar.place "VIP" :
 
Billing Information + delivery address: Credit Card Information:
   
Name: *
Address:
City:
State:          Zip:
Phone: *
Fax:
Email: *
Name on Credit Card *
we'll bill your *
Credit Card Number 
3 digit code on the back
 
*
* i.e. 123
Exp Date: Month *   Year  


REQUIRED FIELDS
* minimum "must" input your info


Pay secure w/ www.PayPal.com to our account 310MrINTERNET@gmail.com Michael Scherich, call after paid

VIP Member Information:       (1 minute shopping!)

after SIGN-UP for VIP above  login here
Instruction: The next time, you like to shop with www.1dollar.place
Just put your "VIP code" in the "VIP field" and you'll shop 100% secure,
without putting any personal information on the Internet.
Comments/Special Instructions: (for preparation, delivery)

 *  CLICK   PLEASE PRINT FOR YOUR RECORD

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