Fax Order Form
fax order to:
320-685-9809
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Customer Information |
|
Customer Name |
________________________________________________ |
Street Address |
________________________________________________ |
City |
________________________________________________ |
State / Zip |
________________________________________________ |
Email address
|
________________________________________________ |
Phone number
|
________________________________________________ |
Item
Information |
|
Wig Name |
________________________________________________ |
Wig Brand |
________________________________________________ |
Wig Color |
________________________________________________ |
Wig Quantity |
________________________________________________ |
Payment Information |
|
Name
on Credit Card |
________________________________________________ |
Billing
Street Address |
________________________________________________ |
City |
________________________________________________ |
State / Zip |
________________________________________________ |
|
|
Credit Card Type |
Visa / MasterCard / Discover /
American Express (Circle
One)
|
Card Number |
________________________________________________ |
Expiration Date |
________________________________________________ |
|
|
Signature |
________________________________________________ |
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By signing above, you are authorizing Name Brand Wigs
parent company Joshua24.com to charge your credit card for the products
ordered plus
shipping and handling charges.
|