(803) 781-5816 • FAX (803) 407-8514 • www.DaisyDuds.com
(803) 781-5816 • FAX (803) 407-8514 • www.DaisyDuds.com
PLEASE PRINT CLEARLY AND FAX TO 803-407-8514
Date ________________
Customer Name ______________________________________________________
Address ____________________________________________________________
City/State/Zip _______________________________________________________
Daytime Phone (_______)_______________ Evening Phone (_______)_______________
Email Address ________________________________________________________
|
ITEM DESCRIPTION |
ITEM COLOR |
THREAD COLOR |
DESIGN NAME or |
INITIALS or NAME |
PRICE |
| PRIORITY MAIL SHIPPING - | TOTAL | ||||
| $4.95 orders up to $25 | 6% TAX (SC only) | ||||
| $5.95 orders $25 to $40 | SHIPPING | $ | |||
| $6.95
orders $40 to $60 $7.95 orders over $60 |
GRAND TOTAL | $ |
Credit Card Number __________________________________________________________________ Exp Date ________________
Name on Card _____________________________________________ Signature __________________________________________