Media on-line order form

CD Solutions, Inc.
100 W. Monument St.
P. O. Box 536
Pleasant Hill, Ohio 45359
Phone:
800.860.2376
937.676.2376
Fax: 937.676.2478
contact@cds.com

Voice 800.860.2376 937.676.2376 Fax 937.676.2478

Credit Card Authorization For
Blank Media Order Form

Please print it then sign this form and fax it to 937-676-2478. If you have problems please use the voice lines at 800-860-2376 or 937-676-2376 or send email to contact@cds.com.

I want to order CD-Recordable discs. The brand name I would like to order is:

I would also like to order the following packaging. Quantity of

How would you like your items shipped?

Shipping Information:
Name: Company:
Address: Line 2
City: State: Zip:
Phone number so we can confirm payment method for this order:

This offer is good only for shipments within the United States.

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