Email Order Form
Fill out and hit submit button at bottom
Please Enter Email Address For Shipment Confirmation
|
|
Ship To:
|
|
|
|
Bill To: (if different)
|
|
|
|
name:
|
|
|
|
name:
|
|
|
|
|
|
business name
|
|
|
business name
|
|
|
|
|
|
|
address 1
|
|
address 1
|
|
|
|
address 2
|
|
|
|
address 2
|
|
|
|
|
|
city
|
|
city
|
|
|
|
zipcode
|
|
|
|
State
|
|
|
State
|
|
|
|
zipcode
|
|
|
|
|
|
|
|
|
|
|
telephone
|
|
email address
|
|
|
|
|
|
Enter Size, Colors, and Amounts Here
|
|
|
|
Pricing
No. of pairs $ Each S/H Total
1 $5.95 $1.95 $7.90
2 $5.45 $2.25 $13.15
3 $4.95 $2.55 $17.40
4 $4.95 $2.85 $22.65
5 $4.95 $2.85 $27.60
6 $4.95 $2.85 $32.55
Additional pairs may be purchased at a price
of $4.95 each with no additional price for
shipping and handling.
You may mix and match sizes and colors,
Mastercard, Visa, American Express and
Discover accepted
|
|
|
|
|
Button Color
|
|
|
|
Lace Size
|
|
Lace Color
|
|
|
Quantity
|
|
|
|
|
|
Enter Total Amount Paid
|
|
|
|
|
|
 |
|
|
|
|
|
credit card type
|
|
|
|
|
|
|
Comments:
|
|
|
credit card number
|
|
|
|
|
|
|
credit card expiration date mm/yy
|
|
|
|
|
