Order Form
Order Form

Please Print Order Form and Mail or Fax to:
P O Box 531, Clyde, TX 79510
Tel: (325) 893-1640        E-mail: sales@ccisilver.com

Our Wholesale Pricing is Based on the Changes in the Daily Asking Price for Silver on the New York Stock Exchange Market. Our Wholesale Prices are subject to change based on the changes in the market.

For Additional Space you may Click Here for Page-2 of the Order Form

Ship to:
Name:
 
 Company:
 
Address:
 
City:
 
 State:
 
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Telephone:
 
 Cell Phone:
 

Item No. Description Unit Qty. Unit Cost Total
           
           
           
           
           
           
           
           
           
           
CCi Industries , Inc.
P O Box 531
Clyde, TX 79510
Tel: (325) 893-1640
Subtotal:
Shipping Charges:
(IL Residents 10%) Tax:
Total Due:
 
 
 

Credit Card Information
 
Check Information
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Credit Card Type:           Check Number:
 
      
  Visa     Mastercard     Discover Amount of Check:
$
    
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Expiration Date:
 
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Amount of Charge:
$
     Driver's License
Authorized Signature:
 
 Authorized Signature: