Cornerstone Sew & Vac

Ebay Auction Winner Form

Your Name* Ebay User ID

Address*

City* State* Zip*

Email*

Phone* Alternate Phone

Ebay Item Number* Item Description*

Payment

Account Number Exp. Date

3 Digit Security Code (on back of card)

Amount to Credit Card*

Personal Check

Certified Check

Money Order

Special Instructions/Comments

By submitting this information I verify it to be true and authorize the above charges to my credit card.

*Indicates a required field

 

Cornerstone Sew & Vac, Inc.
2866-D Chapel Hill Rd.
Douglasville, GA 30135
770-949-5775 • Fax 770-949-3522
info@cornerstonesewandvac.com
©2003, Cornerstone Sew & Vac.  www.JPSWebSolutions.com