CDRDVDRmedia Government Order Form


We accept Government or School Purchasing. Please print out this page, fill in your information and fax it back to us to complete your order.

18961 E. Arenth Ave. City of Industry, CA 91748 http://www.cdrdvdrmedia.com

Tel: (626)912-8886 Ext.101 Fax: (626) 912-0086 Toll Free: (888) 668-6690

Government / School Order

Shipping Info:
Purchase Order Number: Name of Contact:
Name of Agency: Division/Department:
Phone Number: Email Address:
Shipping Address:
                                   


Payment Info:
Type of Credit Card: Name on The Credit Card:
Credit Card Number: Credit Card Expiration Date:
Billing Address:
                              


      Items You Want to Order:
Product Name
Code
Unit Price
Qty.
       
       
       
       
       
       


Special Instructions: