Lady and the Fool-Fax Order Form

Lady and the Fool
Fax:(310) 767-7842
Please be sure to read the Order Information Page BEFORE faxing this form

Name:

________________________________________________________

Home Phone:

________________________________________________________

Daytime Phone:

________________________________________________________

Fax:

________________________________________________________

E-Mail:

________________________________________________________

Street Address:

________________________________________________________

City:

________________________________________________________

State:

________________________________________________________

Zip Code:

________________________________________________________

Method of Payment:

Check Credit Card Money Order

Check #:________________

Credit Card #:

____________________________ Circle One: Master Card Visa AMEX Discover

Iss. Bank:

____________________________ Expiration Date:____________________

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Residents of California add 8.25% Sales Tax:
Shipping:
Total:

I do hereby authorize the above charges on my credit card. Sig:______________________________________________________

Prices subject to change without notice.