| Order Form
Please print our order form and fill in your order information along with your credit card information and special shipping instructions and call 1-866-373-7788 or 1-214-634-3366.
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Bill to |
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| First Name: ______________________ Initial: ________ Last Name: _______________________ | |||||||||||||||
| Address: ________________________________________________________________________ | |||||||||||||||
| City: ____________________________ State: _____________________ Zip: ________________ | |||||||||||||||
| Daytime Phone: _________________________________________________________________ | |||||||||||||||
| Email: _________________________________________________________________________ | |||||||||||||||
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Ship to if same as above check here ( ) |
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| First Name: ____________________ Initial: ________ Last Name: ________________________ | |||||||||||||||
| Address: _______________________________________________________________________ | |||||||||||||||
| City: ____________________________ State: _____________________ Zip: ________________ | |||||||||||||||
| Daytime Phone: _________________________________________________________________ | |||||||||||||||
| Email: _________________________________________________________________________ | |||||||||||||||
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Order Information |
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Style # |
Color |
Quantity |
XS 6 |
S 8 |
M 10 |
L 12 |
XL 14 |
1X 16 |
2X 18 |
3X 20 |
4X 22 |
5X 24 |
Unit Price |
Amount |
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| Total Quanity = | Total Amount= | ||||||||||||||
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Payment Option (Check one) |
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| 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: _____/____/____ |
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| MONEY ORDER / CHECK ( ) | |||||||||||||||
| Please make your Money Order/check payable to DISCOUNT DRESSES and mail it to | |||||||||||||||
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Discount Dresses, 1304 Inwood Road, Dallas, TX 75247 |
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| Special Shipping Instructions (below): | |||||||||||||||
By
signing customer agrees to the following terms and conditions and order
policy:
Customer's Signiture (Required): Signiture: Signiture: ________________________________________________ Date: _____/____/____ |
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