 |
- Please print out this form, fill it out and
send it to:
- SavingsBonds.com Inc.
- 2022 Route # 71 - Suite # 200
- Spring Lake Heights, New Jersey 077620
email:
info@savingsbonds.com
phone:
1-800-717-BOND
- If you are paying by Credit Card,
feel free to FAX this form to 732-280-0264
|
| Name |
__________________________________________________ |
| Address |
__________________________________________________ |
| City |
_________________ State
___ Zip Code ______________ |
| Phone# |
_____________________
Fax #: __________________ |
| Payment
Information: |
| _________ |
Check or Money Order (payable
to SavingsBonds.com Inc.) |
| Card Type |
_____ Visa
_____ MasterCard
_____ Discover |
| Card # |
________________________________ |
| Expiration Date |
_____ / ________
billing zip code ______________ |
Name To Appear on
Statement: _________________________________
| Please
complete the following information for each bond: (use additional pages as necessary) |
| Series |
Face Value |
Issue Date |
Serial # (optional) |
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
Please include any additional bonds on a separate
piece of paper with information arranged in order above. |
|
A.
Specify the number of Bonds and check the appropriate box
(PRICES EFFECTIVE SEPTEMBER 1st, 2001)
|
| Number
of Bonds |
Our Fee |
Your count |
| 1-10 |
$ 16.00
|
______ |
| 11-25 |
$ 30.00 |
______ |
| 26-50 |
$ 38.00 |
______ |
| 51-100 |
$ 62.00 |
______ |
| 101-200 |
$ 77.00 |
______ |
| 200+
|
Call for pricing
|
1-800-717-BOND (2663) |
| Total number of bonds
submitted: ____________ |
NOTE: Statements will be dated in the month the
order is received.
For backdated statements please call 1-800-717-2663 for
details.
| B.
Optional Services |
| Check For Yes |
Method |
Fee |
| ______
|
Same day service*:
*Orders received after Noon
EST will be processed/delivered on next business
day
|
1 to 101 bond: add $ 15.00 to
above cost.
more than 100 bonds: add $ 30.00 to above
cost.
|
| _____ |
Overnight express delivery service |
add $ 15.95 |
| _____ |
Faxing Charge (anywhere in the U.S.) |
add $ 4.95 |
| _____ |
Standard U.S. Mail (no extra charge) |
n/a |
| C. Order
Summary |
| Total Amount from Section A |
$ ________ |
| NY & NJ Residents add 6% Sales Tax |
$ ________ |
| Delivery Charges from Section B |
$ ________ |
| Grand Total (payment amount) |
$ ________ |
|
