SOUTHWEST COUNTRY
ONLINE ORDER FORM

With us you are protected, all your personal and credit card information is kept completely secure. We do not sell, trade or share customers information. All fields must be filled to process your order. Your placement of an order to indicates your acceptance and understanding of our terms and conditions.

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 Full Name:
 E-mail:
Billing Address:

            Residential  Business
 City:
 State / Province:
 Zip / Postal Code:
 Phone:
 Country:
 Item title and quantity to be purchased:
 Please write a clear description and
 the Item's URL/reference number
 from the address bar of your browser.
 Credit Card: VISA
MasterCard
American Express
Discover
Diners Club
JBL
 Credit Card #:
 Expiration Date:


Fill this part of the form if shipping to a different address.
 Shipping Full Name:
 Shipping E-mail:
 Shipping  address:

            Residential  Business
 City:
 State / Province:
 Zip / Postal Code:
 Shipping Phone:
 Country:


When you press the "SUBMIT ORDER" button, the computer will pause as it processes your order. Please do not hit the submit button twice. It is normal for the computer to pause while processing your order.

Your will receive confirmation of your order by E-mail, phone or snail mail. It will have all charge information made to your credit card. If you wish to pay by check or money order, you can print this form and mail it with your payment to:

Southwest Country
17940 Ventura Blvd.
Encino, CA
91316 USA
Please contact with us before sending payment so we can inform you of the shipping costs.

You can also use this form to include yourself to our mailing list.

Back to: Southwest Country Homepage

 

FOLLOW OUR LINKS FOR MORE QUALITY PRODUCTS.

Index of Items | gifts guide | Beds | Metal wall sculptures | Stone Country Iron Works | General Lighting and lamps | rugs | Art Pieces | Oils, Lithographs and Prints | Accessories | Frank Tenney Johnson | Silver Jewelry

THANK YOU FOR YOUR PURCHASE

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