Dash-Mail-Order-Form

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					                                                                                                           PURCHASE ORDER
 Dash Of Sophistication Boutique
 "Dress Present & Future Dignitary"


 P.O. Box 7412
 Wilson, NC 27895                                                                          Order Date:
 Telephone: 1-877-336-1331
 Fax: 1-919-590-1908
 dashsopboutique@hotmail.com
CUSTOMER INFORMATION:                                                                    SHIP TO:
  Name:                                                                                          Name:
 Address:                                                                                      Address:
 City, State:                                                                              City, State:
 Zip Code:                                                                                   Zip Code:
 Phone:                                                                                     Alt Phone:
 (Required) Email:
              CREDIT CARD TYPE                                           CREDIT CARD NUMBER/ EXP. DATE                       CVV/CSC Code (Back of Card)




        QTY                      ITEM #                                DESCRIPTION                              COLOR/SIZE   ITEM PRICE        LINE TOTAL




 1. Please make sure to complete the entire Mail Order Form, and provide correct
 information. Email address is required for shipping & payment notifications.                                                   SUBTOTAL
 2. Credit Card Payments: Credit Card Type is (Visa, MasterCard, Discover, or American
 Express)                                                                                                                       SALES TAX N/A
 3. Fax Orders to: (919) 590-1908
 4. Mail Money Orders/Certified Checks Payments to:                                                                                 TOTAL
 Dash Of Sophistication Boutique
 P.O. Box 7412
 Wilson, NC 27895

 *Payment must be received in full before orders are processed and shipped*
                                                                                                          Authorized by                     Date
 Mail Order form must be signed & dated before processed.

				
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