Fax Form

Please print our order form and fax it to 1-312-896-9522 with your credit card information and special shipping instructions.

 

Bill to
First Name: ______________________ Initial: ________ Last Name: _______________________
Address: ________________________________________________________________________
City: ____________________________ State: _____________________ Zip: ________________
Daytime Phone: _________________________________________________________________
Email: _________________________________________________________________________
 

Ship to if same as above check here (   )
First Name: ____________________ Initial: ________ Last Name: ________________________
Address: _______________________________________________________________________
City: ____________________________ State: _____________________ Zip: ________________
Daytime Phone: _________________________________________________________________
Email: _________________________________________________________________________
 

Order Information

Style #

Color

Quantity

XS

6

S

8

M

10

L

12

XL

14

1X

16

2X

18

3X

20

4X

22

5X

24

6X

26

7X

28

Unit Price

Amount
                                 
                                 
                                 
                                 
                                 
 Total Quanity = Total Amount=

Payment Option (Check one)
CREDIT CARD     (    )
Credit Card Number: ______________ /_______________ /______________ /_______________
Expiration Date: _______ /______ /______
Credit Card Type (Please circle one): Visa / MasterCard / AMEX / Discover
Cardholder's Name (as it appears on the card): ___________________________________________
Cardholder's Signiture (Card Holder Aggrees to pay Discount Dresses the Total Amount above: 

Signiture:  ________________________________________________   Date: _____/____/____
MONEY ORDER / CHECK    (     )
Please make your Money Order/check payable to DISCOUNT DRESSES and mail it to 

Discount Dresses Online, 2226 W. Barry Avenue, Chicago, IL 60618
Special Shipping Instructions (below):
By signing customer agrees to the following terms and conditions and order policy:
  1. Non-authorized refusal/returns will result in freight claims.
  2. Please allow 48 hours  for the order to be processed and shipped.

Customer's Signiture (Required): Signiture: 

Signiture:   ________________________________________________   Date: _____/____/____