mail/fax ordering form

Before using this mail form please contact us in advance to make sure everything is in stock, get a shipping quote, and to make sure you will be meeting our $20 minimum order requirement. Thanks.

Please note that due to increased credit card security, the address you provide must match the address on file with your credit card company. Thanks.

Please fill this out completely and then mail or fax it to us.

Southeastern Skate Supply
PO Box 12448
Roanoke, VA 24025-2448
ph 540-342-7871
fax 540-342-7873

Your name:______________________________________

Company name:__________________________________

Address:________________________________________

Address 2:_______________________________________

City/State/Zip:_____________________________________

Phone:___________________________________________

Credit Card Number:_________________________________

Exp Date:_________________________________________

Name on Card:_____________________________________

Signature:_________________________________________

CVV Code:________________________________________
(This is a small number printed on the card for security purposes. On an AMEX card it is 4 digits and is usually located above and to the right of the card number on the front of the card. On a Visa or MC it is 3 digits and is usually located on the back of the card, near the signature stripe, after the card number).

the order:

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