Fax Your Order Now!

OneRom Group, Inc.

244 Fifth Avenue, Suite C241, New York, NY 10001, USA

To order by fax, please follow these simple steps:

1. Type in all the information below (* indicates a required field).

2. Print this order form. 

3. Sign this order form in "Your Signature" field at the bottom. 

4. Fax this order form to (212)591-6810. 

5. Send us an email indicating you have ordered by fax.

That's it! As soon as we receive your fax order, we will process your order immediately. 

 

*Product Information


*Product Name:



*Product Quantity:


 

*Billing Information (This must be the same  as the billing address on your credit card.)


*Name:



*Street Address:





*City:



*State/ Province:



*Zip Code:



*Country:


 

Shipping Information (Fill in this only if it is different from the billing address.)


Name:



Street Address:





City:



State/ Province:



Zip Code:



Country:


 

*Contact Information


*Telephone:



Fax:



*Email Address:


 

*Credit Card Information


*Name of Credit Card Owner:



*Credit Card Type:



*Credit Card Number:



*Verification Number:



*Expiration Date:


 

*Your Signature: ___________________________________________