Defcon Sauces // ZERO Batch #5 Release order form

Section 1: ZERO Batch #5 - Items to order
Number of Batch #5 collectable sets: MAXIMUM OF 2*	Not at this time 1 2 - Maximum allowed per person
Preferred number on bottle:	(1st, 2nd, 3rd, etc... choices)
Do you want to purchase a Batch #5 taster bottle: ONLY ONE PERMITED	NO YES - An additional $25.00 USD
Section 2: Shipping Information Only All Fields Required*
Name:
Address:
City:
State/Province:
Postal Code:
Country:
Phone:
*Email:

Method of payment: SELECT ONE*	Pay Pal Invoice - Go To Section 3 Credit Card - Go To Section 4
Section 3 - Pay Pal Invoice only Enter the email address for your Pay Pal invoice? Skip down to Final section (5) Do not complete section 4
Section 4 - Credit Card orders only * Indicates a required field All information must apply to the card being charged.
*Name:
* Billing Address:
*Billing City:
*Billing State/Province:
*Billing Postal Code:
*Country:
*Phone:
*Card Type:
*Card Number:	(xxxx-xxxx-xxxx-xxxx)
*Exp. Date:	(mm/yy)
*Security Code:	(on back of card)
Section 5 - Final section Finally .... Once all information has been received, you will receive either a Pay Pal invoice or an email confirmation regarding your credit card transaction.
Comment/Questions:
We here at DEFCON HQ would like to thank you for your order.