Playstation 2 Order Form

Due to excessive demand, orders usually take upwards of 6 - 8 weeks. All extra peripheral devices will take 3 - 4 weeks before delivery. All Playstation 2 Consoles come with 1 Dual Shock 2 Controller, 1 AV Cable, 1 AC Power Cord, and 1 set of printed materials. A maximum 5 Playstation 2 consoles per individual. If anymore then 5 Playstation 2 consoles are needed for personal or retail use please contact the following number. 1-800-555-5555

Please provide the following contact information:

Name
Work Phone
Home Phone
E-mail

Please provide the following ordering information:

QTY DESCRIPTION

BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Please identify and describe yourself: (Optional)

Date of Birth
Sex Male Female
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Sony Computer Entertainment America
Copyright © 2001 [Sony]. All rights reserved.
Revised: May 06, 2001