Order - Credit Card

Payment by CREDIT CARD

We do not have the facilities for credit card transactions over the Internet; therefore, if you wish to pay by credit card, please print out and mail or fax the order form below to :
PalMart Trading & Contracting Co.
P.O. Box 54161
Jerusalem
Telefax : 972 2 5836438

Please charge to my credit card:

__Access __Amex __Diners __Eurocard __Mastercard __Visa

Card No. __________________________
Exp.___________________ Signature_______________________
Name________________________________
Address____________________________________
City/Code/Country_______________________________
Tel/Fax_________________________
Email Address (necessary)___________________________

Order (code)_____________ Quantity_____ Options*_____________________
Order (code)_____________ Quantity_____ Options*_____________________
Order (code)_____________ Quantity_____ Options*_____________________

Address you want your order(s) sent to_________________________________
City/Code/Country____________________________
Personal Message to be included with order (optional):

(*e.g. "red, large, rectangular", if applicable)