Secure Order Form - Schroeder's Book Haven

Schroeder's Book Haven
104 Michigan Avenue League City, Texas 77573	info@BookHavenTexas.com
281-332-5226 800-894-5032	Your Full Service Bookstore

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SECURE ORDER FORM
This form allows you to send shipping, billing & payment info to us via our Secure Server.
There is NO automated processing of your card, we manually process each order.
Any information submitted here is held in the strictest confidence.
We do not sell, trade or in any other way distribute customer info to others.

Kindly provide the following contact information:
( Use TAB key to move between fields, as ENTER submits form)

email
Required

Please Double-Check email for accuracy, as this is how we contact you

Name

Organization

Address

Address 2

City

State/Province

Zip/Postal Code

Country if outside US

Work Phone optional

Home Phone optional

BILLING / PAYMENT INFO:

Method

Cardholder name

Card/PO Number

Expiration date (mm/yy format)

Amount Authorized

Please include any comments or instructions regarding your order / inquiry:

Please provide the following book info:
(Not necessary if you are simply using this form to securely send credit card info).

Item # Title (first few words is usually sufficient)

Ship Via:

SHIP TO: (Only if different from above)

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Contents Š1999-2011 Schroeder's Book Haven 104 Michigan Avenue League City, Texas 77573
Questions / Comments / Problems about Site Webmaster@BookHavenTexas.com	281-332-5226 800-894-5032
[ Home Page ]	email: info@BookHavenTexas.com

email	Required
Please Double-Check email for accuracy, as this is how we contact you
Name
Organization
Address
Address 2
City
State/Province
Zip/Postal Code
Country	if outside US
Work Phone	optional
Home Phone	optional

BILLING / PAYMENT INFO:
Method
Cardholder name
Card/PO Number
Expiration date	(mm/yy format)
Amount Authorized

	SHIP TO: (Only if different from above)
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Last revised: December 27, 2007