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On-Line Order Form

Company Name
Contact Name
Address
City
State      Zip
Telephone ***
Fax
E-mail
Payment Information:

Card Type:     

Card Number: 

Expiration Date: Month: Year:

(Your credit card number and your personal information is protected.)
Shipment Information: ( leave blank if same as above ) :
Ship-To Address
City
State      Zip
Telephone

Ship Via:

UPS Ground   UPS 2nd Day
UPS Over Night   US Mail
***Add $10.00 for US Mail. $12.00 for UPS Ground. $15.00 for UPS 2nd day.$25.00 for over night.

Please fill in as much information as possible to help speed delivery:


 TOTALS :
(your total, including shipment and taxes will be emaled to you
before we charge your credit cart.
You can estimate your total below).

* For California Residence: Please add 8.25% sales tax on every order,
To help you calculate the tax please use this calculator:
Enter SubTotal into the second field and press Calculate.
Add the Tax to your SubTotal and Place the new total in Estimate Order Total.
What is % of ? Answer:

                                                      

Please enter any comments, color preferences,
special instructions, etc., regarding your order:

         
 Make sure we have your phone number!

Please contact us for:
Catalog · Catalog Information · More Styles
Pricing · Special Sales in Large Quantities

2089 Westwood Blvd. · Los Angeles, Ca  90025

Tel:   (800) 743 - 5597   ·   Fax:   (310) 470 - 6125

E- mail:   shellysdancewear@aol.com

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