Gemini Publishing Co. Secure Order Form
Warning: When entering data in this form please do not use the Enter key on your keyboard. Use your mouse & cursor to enter data.
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*  
Enter Item# with Description, Price and Quantity
Item 1:*    
Item 2:    
Item 3:    
Item 4:    
Item 5:    
Item 6:    
Item 7:    
Item 8:    
Sub-Total:  
Tax (TX 6.50%):  
Shipping for U.S. Orders  
Shipping for Canadian Orders:  
Shipping for Foreign Orders:  
Grand Total:  
*Quantity discounts will be deducted from your total when credit card is charged
Billing Information
First Name*  
Middle Initial:  
Last Name:*  
Address Line 1:*   Where your statement is mailed
Address Line 2:   Apt. or Suite No.
City:*  
State:  
Country*  
Zip Code/Postal Code:*  
Phone:  
Shipping Information
Same as billing info:*
Yes No 
Payment Information
Payment Method:*
Credit Card 
For Those of You Who Wish to Pay for Your Order Using PayPal Click Here                       
Card Number:*   No dashes or spaces please
Expiration Month:*   From your card
Expiration Year:*   From your card
Card Brand:*  
Comments:  
  Remaining Characters
1000 Character Limit
Gemini Publishing Co., PO Box 57931, Webster, TX 77598, 281-741-4424, Website: www.getgirls.com, email: getgirls@getgirls.com


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