Disney and More Iron On Appliques
Fax Order Form - Fax# (toll free) 1-866-906-6005
Billing Information - Exactly as it appears on your credit card statement.

First Name: ____________________________________

Last Name: ____________________________________

Card Type: Visa___ MasterCard ___ Discover___ American Express___

Card Number: ______________________________

Expiration Date: ___________________

Card Verification Number:_________________
       ( final 3 digit number on card back)

Total amount of charge: $___________________

Email Address: ____________________________________

Home Telephone: (_____)_______________

Address 1: ____________________________________

Address 2: ____________________________________

City: ____________________________________

State: ______________________

ZIP Code: ______

Shipping Address if different from billing address:

Address 1: ____________________________________

Address 2: ____________________________________

City: ____________________________________

State: _______________________

ZIP Code: ______

Item Description                                                    How Many    Cost Each    Total Cost

1.____________________________________________________________     ________     $_______     $________

2.____________________________________________________________     ________     $_______     $________

3.____________________________________________________________      ________     $_______     $________

4.____________________________________________________________     ________     $_______     $________

5.____________________________________________________________     ________     $_______     $________

6.____________________________________________________________     ________     $_______     $________

7.____________________________________________________________     ________     $_______     $________

8.____________________________________________________________    ________     $_______     $________

9.____________________________________________________________     ________     $_______     $________

10.___________________________________________________________     ________     $_______     $________

11.___________________________________________________________     ________     $_______     $________

12.___________________________________________________________     ________     $_______     $________

Discount: $_________      Shipping Cost: $__________                       Total amount of charge: $______________