PT Shamrock's Order Form

PLEASE use this ORDER form for credit card payments via PayPal UP to, but NOT more than US$150. Please insert "PAYPAL" inside the "Comments/Questions/Feedback" box at the bottom of this ordering FORM. Otherwise your order via credit card/PayPal order and payment will NOT be accepted. Thank you

Any questions just email PT Shamrock via CONTACT US.
 

First Name:
Last Name:
Address:
Zip Code:
City:
State:
Other State:
Country:
Telephone:
Email: Do not use an AOL e-mail address as AOL rejects our e-mails.
Currency:

Product Name: Price:
5% Credit Card Surcharge for all credit card orders.
Shipping and handling (if any):
Total Order:

If Ordering Mail Drop
Name of Country:
Price:
Name's to Receive Mail In
Name and Address to Forward Mail To:
E-mail Contact:
Code or pin number to authenticate changes at your mail drop:

Billing Information
Credit Card Type:
Name on Card:
Credit Card Number
Expiration Date: (Month-Year)
CVV2 Help

Shipping Information
Same as billing address.
Full Name:
Address:
City:
State:
Other State:
Zip Code:
Phone:
Country:
  To stop SPAM robots, please enter the 6 digit security code in the box below and remember the 6 digit code is case sensitive.
Security Code:

Comments/Questions/Feedback

Terms & Conditions
I have read and agree to the Terms & Conditions, by clicking the submit button your order is sent automatically via our SSL Secure Order Form.
PLEASE NOTE: Please all credit card orders are via PayPal up to but NOT exceeding US$150. Thank you.