Mr. Shims Order Form

(800) 72-SHIMS * FAX (630) 832-5744

Secure Order Form

Fill in all information that applies and click on the "Send Order" button to electronically send your order or use our printable order form, then print and mail or fax it to us.

We believe transmitting credit card information on the Internet is as safe as using over the telephone or sending through the US Mail, however we cannot guarantee it's safety. Therefore, Mr. Shims utilizes the Secure Server of our web host, Google at appspot.com, to increase the safety of your credit card transaction. By using this Secure Server, your credit card information is encrypted, protecting it from being read by any outside source.

Ordering Information
Please note: required information is in RED^*
Note: An address or optional shipping address is required.

Company Name:
Purchase Order #:
*Full Name^:**
Title:
Address:
City:
State/Prov:
ZIP/Postal Code:
Country:
*Telephone^:**
*Email^:**

Optional Shipping Method
The default shipping method is UPS Ground.
Select an Alternate method if desired.

UPS Ground
UPS
Next Day Air
2nd Day Air

All orders other than ground should be
confirmed with us by phone call.

Optional Shipping Instructions,
if different from above:

Ship To:
Shipping Address:
Shipping Instructions:

Product Selections

Payment Information

Select Payment Method^*
(required)

Credit Card
Check
Money Order

Credit Card Information
Type of Card:
Name on Card:
Card Number:
Expiration Date:
Security Card ID: Click here for more info

If you are ordering by mail or fax print this form and send it to us.
Otherwise click the "Send Order" button below to finalize your order.

The information you provide Mr. Shims will not be shared with others
(third parties) and will be used for internal business purposes only.