Please complete and print this form. Then, mail or fax to: SMS INDUSTRIES,INC. · 1764 Norland Road · Charlotte, North Carolina 28205-5706Fax: 704/537-2385
Company Name:
Person Placing the Order:
Billing Address:
Shipping Address:
Phone:
Fax:
Email:
All new orders must be prepaid. Company Check will be accepted only with approved credit information on file.
Payment Type:
Net 30 C.O.D.C. Prepay Credit Card
Visa Master Card Amex Discover
Card Number:
CVV2#:
Expiration:
Name on Card:
I, _________________________________________________, hereby authorize SMS Catering
Services, Inc. to charge my credit card for the amount of $_____________________.