Secure Order Form

Brookman Stamp Company
Supplies & Other Stamps
info at brookmanstamps.com
Toll-Free: (800)545-4871
Local: (360)695-1391

Our secure server software (SSL) is the industry standard and among
the best available for secure e-commerce transactions. It encrypts all of your
personal information, including credit card number, name, and address so
that it cannot be read as the information travels over the Internet.

			Quantity	Price	Total
Entry 1				$	$

NOTE: INDICATE GIFT CHOICE IN THE SPECIAL INSTRUCTIONS AT THE BOTTOM BEFORE SUBMITTING

----------------------------------------------- Grand Total: $

Shipping Info
*First Name:
*Last Name:
*Address line 1 Shipping will be sent to the address used for your credit card billing.

*City:
*State:
*Zip:
*Country:
*Phone:
Work Phone:
Fax:
*Email:

*First Name / initial: .*Last Name:

*Card you are using: *Card number: (no dashes or spaces)

*Expiration month / year: *AVS Code:

MC/Visa: Located On back
AMEX: Located on front

Special Instructions & Comments: