MESS DRESS ORDER FORM
Please print out this order form, fill it out and fax or mail it to the address below. Please call us if you need assistance.
You may pay by MasterCard or Visa. Or you may send a personal check. Mail your payment to:
Mess Dress, 1301 Bumps River Road, Centerville, MA 02327 USA Tel.: +1 508 775-2215 FAX: +1 508 790-1674

SHIP TO:                                       ____CHECK ENCLOSED

NAME


COMPANY

STREET ADDRESS

CITY                          STATE/PROV                         ZIP/POST CODE                                              COUNTRY
TEL                                                FAX                                                        EMAIL
    

QUANTITY

ITEM NUMBER & NAME

PRICE









 

 






Sub Total___________________________

Shipping____________________________

Tax _______________________

Total_______________________

I authorize MESS DRESS. to debit my charge card in payment for the above ordered items.

Please check off the appropriate charge card, fill in your complete card number with expiration date and sign where indicated. Fill in the name printed on the card and the address where your credit card statement is mailed. Fax or mail this sheet to Mess Dress.
Thank you

BILLING INFORMATION

Account # (all 15 or 16 digits)
______________________________________
Expiration Date(mo/yr)____/____

Signature________________________________________
Name on card____________________________________
Street Address___________________________________
City__________________St/Prov_______ZIP__________
Tel. No. +(Area Code)_______________________________
 
 

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