Private Purchase Order Form ( Column, article ).

Date: ___________________________________

First Name: ____________________________ Last Name: ___________________________________

Address: ________________________________________________  City: ______________________

State / Province: ____________  Zip / Post Code: _______________  Country: _____________________

Phone No: ( ____ ) ________________________ Fax No: ( _____ ) ____________________________

E-mail: __________________________________________ Other: _____________________________

Column, article description or Number: _____________________________________________________

__________________________________________________________________________________

Total Number of Articles / columns :________ Total Amount: $_______ in US.   Prepaid shipment: $________

The amount must be approved with sales or operations (enter the approval code) : _____________________ 

Your Method of Payment:               No COD's. 

Type of Credit Card : ____________ Holder's full name : ________________________________________

Card number : __________________________________________  Exp. date : ____________________

Western Union - Money transfer control number : _______________________________________________ 

Money Order by :______________________________________________________________________ 

Entry details: _________________________________________________________________________

For personal use only: 

I understand that the materials are copyright protected, and without FPINS.,  or writer's  
written permission cannot be used for publishing or commercial usage. 

 _________________________________      ______________________   _______________________
Signature                                                           Date:                                       In:      

Fill out the order form with all details, sign and by e-mail to: FPINS Writers

To confirm your shipment or order call: (705) 745-5770