MAIL-ORDER FORM
Print out this order form and fill in all the required information. Please don't forget to make sure the credit card information is accurate. Mail the completed form to the address listed below. Thank you for your order.
Your Billing Information: Your Shipping Address:
Name:__________________________ Name:__________________________
Street:__________________________ Street:__________________________
City and State:____________________ City and State:____________________
Zip Code:________________________ Zip Code:________________________
Phone Number:_____________________
Fax Number:_______________________
Email:_____________________________
Special Instructions:_______________________________________________________________
The Plus Size Lingerie Items You Are Ordering, if more space is needed use the back of form
Quantity______Item# _________ Color__________ Size__________Cost_______
Quantity______Item#__________ Color__________ Size_________ Cost_______
Quantity______Item#__________Color__________ Size_________ Cost_______
Quantity______Item #_________ Color__________ Size_________ Cost_______
Sub Total including back:_____________
Shipping/Handling Total:_____________
NYS Tax 8 1/4%: ___________________
Total to Remit:______________
Credit Card Information:
Mail Completed Form to:
Name On Card:________________________ T LC Boutique 3639 Atwood Road
Card Type:____________________________ Stone Ridge, NY 12484
Card Number:__________________________ C V V #_______
Expiration: Month:________ Year:___________
Authorized Signature
______________________________________
