Cover Order Form

Secure Order Form

Semco Teak Care New Products Order Form
This form may be submitted electronically or filled out and then printed out so it can be faxed to us.

Our Fax # 410-771-4057

Please fill out all required information below and submit your order. This page is secure. We appreciate your business.

Billing Information: *Required Information

Quantity	Item #	Description of Item	Price each	Total Please extend amount for multiple items.



		Sub Total
		Shipping and Handling
		Total

Please enter the following information: *Required Information
* Credit Card Type (select one):
* Card Number:
* Expiration Date:
* CID Number (3-digit number on back of card):
* Name on Card:
Shipping Information: (Fill in info if different from billing address.)
Name:
Address:
Address:
City, State & Zip Code:
Phone # with area code:
Comments or Special Instructions: