HBIU Certificate Order Form

HBIU Certificate Order Form
Order Date

MonthDayYear
Date
Customer Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Is the shipping information the same as above?

YesNo
Shipping Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Order & Payment Information
Order Products
prevnext( X )
Men Certificate Gown$65.00

QuantitySize

Women Certificate Gown$65.00

QuantitySize

Subtotal $0.00Tax $0.00Shipping $0.00Total $0.00
Payment Method
Please check Yes stating I do understand all payment is final

YesNo
Please complete if you are buying for more that one person:
Remarks / Special Instructions
Note: After submitting this form, we'll check your order and we'll contact you within 24-48 hours for confirmation.

For more than 5 orders: Before we proceed on producing the products, we'll create a mock-up and we will send it to you for approval.
Please copy this link to make your payment before you submit your application (USD Payment Method)

https://buy.stripe.com/6oE9DxcYf8f16nS7tC
Should be Empty:

Customer Information