| L D FASHIONS |
print this form for regular mail
NAME____________________________________________________________
ADDRESS_________________________________________________________
CITY_______________________________ STATE______ ZIP________________
Please make checks or money orders payable to L D Fashions
VISA__ M C__ Your name as it appears on card __________________________________
CARD NUMBER__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ ___ EXP __ __
SIGNATURE _______________________________________________________
| QUANTITY. | DESCRIPTION | COLOR | 2ND | UNIT COST | TOTAL |
| TOTAL MERCHANDISE | |
| less coupons or credits | |
SUBTOTAL |
|
| sales tax applies to Illinois residents only tax rate 6.75% (.0675) Tax | |
| SHIPPING $8.95 | $8.95 |
| TOTAL |
EMAIL (optional) _______________________________________
| height | weight | waist |
| sleeves | neck | shirt (mans) | suit( mans) | ||||
| dress | bra | corset waist |
PLEASE ADDRESS ORDERS TO
| LD FASHIONS |
| 440 Lockwood CT |
| Davis IL 61019 |
VISA/ MASTERCARD