The Hawai'i Store
Fax Order Form
Print a copy, fill in
information and fax to 808-841-8829 |
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Item # |
Description |
Size |
Color |
Unit Price |
Sub Total |
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Due to the wide variety of our merchandise,
which includes perishable items that need to be shipped more
expediently, we are unable to include standardized shipping charges
within this form. Shipping charges will be calculated once this
form is submitted and we will contact you with a total charge.
This form is not a binding agreement and you may choose to cancel
your order at any time prior to your payment. Some higher priced
and personalized items require pre-payment to process order.
Personal checks must clear bank before order is shipped. |
Contact Information
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Name: |
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Date: |
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Phone/Fax : |
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E-Mail: |
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Your personal
information will not be shared with anyone |
Billing Information
(If paying with credit
card, billing information must match credit card information)
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Name: |
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Street Address: |
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Street Address line 2: |
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City: |
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State: |
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Postal Code: |
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Providence (non-USA): |
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Country: |
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Shipping Information
(If different from billing
Info)
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Name: |
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Street Address: |
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Street Address line 2: |
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City: |
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State: |
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Postal Code: |
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Providence (non-USA): |
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Country: |
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Payment Method
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VISA # |
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Expiration (xx/xx) |
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Master Card # |
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Expiration (xx/xx) |
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DISCOVER # |
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Expiration (xx/xx) |
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AMEX # |
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Expiration (xx/xx) |
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Other Methods of Payment. (Please
check one) |
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Personal Check |
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Money Order |
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Cashier's Check |
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Please sign below if paying with
Credit Card.
Your signature authorizes card use |
Enter Credit Card Security Code below
Last 3 digits on M/C & VISA card back
or 4 digits on front of AMEX |
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Please read ordering terms
and initial below or your order may not be processed.
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