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.
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First Name:
____________________________________ Last Name: ____________________________________ Card Type: Visa___ MasterCard ___ Discover___ American Express___ Card Number: ______________________________ Expiration Date: ___________________ Card Verification Number:_________________ 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: ______ |
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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: $______________ |