WHEEL OF INTOXICATION ORDER FORM

WHEEL OF INTOXICATION^TM ORDER FORM

Quantity Description $/each Total $_

______ Wheel of Intoxication Board Game 24.95 _______

______ _______________________________ _______ _______

SUB-TOTAL

Maryland Customers add 5.0% Sales Tax

Basic Shipping (5-8 Business Days) $5.00

Select Shipping (3-5 Business Days) $9.95

Premium Shipping (2-3 Business Days) $15.95

GRAND TOTAL

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Customer Name:

Customer Address:

Customer City//State/Zip

Email Address

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Is this a gift? __Y __N Add Gift Announcement? __Y __N

If this is a gift, please include shipping address.

Ship-To Name:

Ship-To Address:

Ship-To City/State/Zip:

______________________________________________________

If Paying By Credit Card

We accept credit card orders by mail, phone, and fax (see below).
Print name as it appears on card: ______________________________
Check one: ______ VISA, ______ MASTERCARD
Card #: ________________________________________________Expiration Date: ___________
Signature of Cardholder: ______________________________________________________________________

If Paying By Check or Money Order

Make check or money order payable to: Boingo Games

Mail check or money order, plus this completed form, to the address noted below.

Mailing Address: Boingo Games, 16204 Cannfield Drive
Laurel, MD 20707

Phone Orders : 1-443-414-4955

Fax Orders To: 1-240-524-2332

Quantity	Description	$/each	Total $_
______	Wheel of Intoxication Board Game	24.95	_______
______	_______________________________	_______	_______