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........Fill out "All
Information" on Form then "Submit"
SHIP
TO: Name:
Address:
No P O Boxes
City:
State:
Zip Code:
*Phone Number:
* Email:
*
Required field (s) Phone and Email
to enable Shippment
PLEASE
TYPE THE ITEMS YOU WANT TO ORDER BELOW:
Qty
-..Item Number.-.Description.-.Fragrance
WEBSITE
PRICES WILL BE APPLIED TO ABOVE ITEMS ORDERED PLUS SHIPPING
| Order
Amount |
Shipping
Fee |
| $
1.00 |
$
30.99 |
|
$
10.45 |
| $
31.00 |
$
100.99 |
|
$
13.60 |
| $
101.00 |
$
200.99 |
|
$
16.99 |
| |
|
|
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PLEASE CHOOSE A PAYMENT METHOD
CARD NUMBER: (xxxx-xxxx-xxxx-xxxx)
CVS#
(3 DIGIT SECURITY CODE ON BACK)
CARDHOLDER NAME:
EXPIRES (xx-xxxx)
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