Glamour Boutique Order Form

5 Birkendene Road
Caldwell, NJ 07006
www.glamourboutique.com
Fax: (973) 226-5589
E-mail: dhborrows@gmail.com

You can print this order form and mail or fax a completed version to the above address.

Ordered By:

Name:
Street:		Apt.#:
City:		State:
Zip:	Country:
E-mail:

Billing Address (Use only if different from 'Ordered By')

Name:
Street:		Apt.#:
City:		State:
Zip:	Country:
Phone:

Order Details

*Item#*	*Size*	*Description*	*Color*	*Price*	*Quantity*	*Subtotal*
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
Discount %				Code:		-$
Total for Goods						$
Shipping		Foreign $25.95 Canada $12.95		Domestic $6.95		$
Total Amount Due						$

Payment

You may pay by check or money order payable to: Glamour Boutique or, if you would like to pay by credit card, you may do so by entering your card type and number below:

Visa MasterCard American Express Discover

Credit Card #: Expiration Date: CVC Code:

For your safety and security,
our card processing server requires that you enter your Card Verification Code number, if one is available.
The Card Verification Code number is a 3 or 4 digit number printed on your card.
If you are using a Visa, Mastercard, or Discover card, it is a 3 digit number that appears to the right of your card number !
If you are using an American Express Card,
The "CVC" Code is on the front of the Credit Card !

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