Soul of the Warrior
104 Hunters Wood Drive
Summerville South Carolina 29485 USA
Orders (843) 475-0095 Message: (843) 437-5587
Name:__________________________________________________________________
Shipping Address 1:_______________________________________________________
Shipping Address 2:_______________________________________________________
City: ________________________________State:______________________________
Postal Code:__________________________
Country:___________________________
Phone Number:________________________ Email:_____________________________
Items Number:
Description:
Quantity: Cost: Total:
Sub total:________________
Discounts:_______________
Tax (6% SC only):________
Shipping(10%):___________
Total:__________________
Payment by: ___Check ___Money Order ___ Credit
Card___ Gift Certificate
Billing Information:
Credit Card Type: _____________________________________________
Credit Card Number:___________________________________________
Exact name on Credit Card :_____________________________________
Expiration Date of Card:________________________________________
CVV Security Code: ___________________________________________
Billing Address (If different than shipping):_________________________
I authorize Soul of the Warrior LLC to bill my credit card for the above amount. Furthermore I agree to abide by the cardholder agreement.
______________________________________
________________________
Cardholder
Date
RAT Discount Information: Screen Name:_____________________________________
RAT Discount is 10^%,
please subtract from above on the last line.