Real Bodies Clothing from Bali Order Form      Date:  ___________

 

Billing Information

Name:

Address:

Address:

City:                                                   State:           ZIP:                      Country:

Phone:

Email:

 

Shipping Information (ONLY NEEDED WHEN DIFFERENT FROM BILLING INFO)

Name:

Address:

Address:

City:                                                   State:           ZIP:                      Country:

Phone:

Email:

 

Delivery Options

q Standard (USPS Priority)      q Express (USPS Express)      q Other:

 

Payment Information

q MasterCard   q Visa   q American Express   q Discover   q Other:

Card Number: oooo  oooo  oooo  oooo

Amex: 4 digits on card front

Others: 3 digits on card back

 
Expiration:  Month:oo  Year:oo CVVoooo

 

Selection Information

Item

Description

1st Fabric

2nd Fabric

Size

Price

Qty

Total

 

 

 

 

 

$

 

$

 

 

 

 

 

$

 

$

 

 

 

 

 

$

 

$

 

 

 

 

 

$

 

$

 

 

 

 

 

$

 

$

    $0.00 -   $99.99      $6.00

$100.00 - $199.99      $8.00

$200.00 - $299.99      $10.00

$300.00 - $399.99    $12.00

$400.00 - $499.99    $14.00 (and $2.00 for each additional $100)

 

Add $20.00 outside continental United States.

Add $18.00 plus $1.00 per garment for rush delivery.

Add $38.00 plus $2.00 per garment for rush delivery outside U.S.

 

Subtotal  $

 

Shipping  $

Total        $