completely and fax to: 402.339.4511
| SHIPPING - Where you are sending the order: |
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| PAYMENT - The person paying for the order: |
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| Address: |
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| Phone: *Email: |
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| *Please provide us with an email address so we may send you a confirmation email and contact you with any questions regarding your order. |
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| Credit Card Number: |
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| Type of Card (Visa or MasterCard): |
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| Expiration Date: _______ / _______ / _______ |
| Style No |
Description and Color |
Qty |
Unit Price |
Total |
| Comments: |
Sub-Total |
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| NE Sales Tax Nebraska Residents add 7.0% |
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| Order Total* |
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| Shipping: Standard, Express, or Rush *Shipping charges will be added |
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| Signature: |
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| By signing, I authorize Destination Dress Company to collect payment for the products ordered above and associated shipping charges. We cannot ship your order without your signature. Please fill out form completely and fax to: 402.339.4511. We will send you an email confirmation of your order. |
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