Please complete form.
Then print and fax info to: 1- 816-436-5880 or scan and email to info@whattimeisit.net

Name
CC Billing Address
Address (cont.)
City State /Prov
Zip/Postal Code Country
Work Phone Home Phone
E-mail

Please provide the following item information:

Ref # Color Size	Watch / Gift / Strap / Case
	US $
	US $
	US $
	US $
Sub $
Ship $	**Shipping Fees Int'l Shipping Fees**
Tax $	Missouri residents add 7.2% sales tax
Total $

	BILLING Information
Credit Card /Other
Cardholder Name
Card Number Expiration
Bank Card Code	3 digit - MC Visa / 4 digit Amex
Bank Card Issuer
Bank Card Telephone #
Signature

	SHIP ITEM TO:
Street Address
Address (cont.)
City
State / Province
Zip /Postal Code /Country

Special Info:

Please Print This Form & Fax To:: 1-816-436-5880
Or Scan & Email To: info@whattimeisit.net
International Calling Codes

Questions or Problems: Please call 1-816-420-9085 or e-mail info@whattimeisit.net
THANK YOU!!

5510 NE Antioch Rd. - Kansas City, MO 64119
Toll Free 1-877-856-1173
John Putnam & Associates - Member NAWCC #0138626