LOVELY PUMPS ORDERING - CREDIT CARD BILLING FORM
- WE ACCEPT VISA or MASTERCARD -
Please fill the blanks carefully
and send us this form by fax
(You need to use
this form seperately for every different model. If you wish to order
the same model in
different quantities -more than single pair- you can use this form
once)
YOUR
NAME & FAMILY NAME :
.......................................................................................................
YOUR FULL ADDRESS :
COUNTRY :
................................................................................................................................
STREET :
...................................................................................................................................
CITY :
.......................................... STATE :
.......................................... ZIP CODE :
...................
YOUR PHONE NUMBER(S) :
HOME :
......................................................... OFFICE :
.............................................................
FAX (OPTIONAL) :
.......................................................
ITEM DETAILS :
Shoe / boot model :
.......................................................................................................................
Quantity :
.......................................................................................................................................
Total price :
...................................................................................................................................
Extra properties :
...........................................................................................................................
AUTHORITY TO WITHDRAW MONEY FROM CREDIT CARD
I hereby authorize Lovely Pumps to withdraw the amount appearing here
below for the
following item(s) :
Please
fill the blanks
below:
Model :
.........................................................................................................................
Size
(US, UK or EUROPEAN) :
.........................................................................................................................
Heel
height (inches or centimeters) :
.........................................................................................................................
Color
:
.........................................................................................................................
Feet
length in centimeters (optional) :
.........................................................................................................................
Feet
width in centimeters (optional) :
.........................................................................................................................
* Anklestraps
(yes / no) :
.........................................................................................................................
* Slingback
(yes / no) :
.........................................................................................................................
* V
type vamp (yes / no) :
.........................................................................................................................
* Metal
heel (yes / no) :
.........................................................................................................................
Extra
information :
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
( * ) May not be available for every model. See
our pages and lists please.
Please fill the blanks for credit card
details (all fields are required) :
Card owner's name and surname :
Card type (VISA or MASTERCARD) :
CARD NO :
CVC2 :
EXP. DATE :
/
TOTAL AMOUNT :
US $
DATE :
.........../............/.............. (MM/DD/YY)
SIGNATURE :
|
THANK YOU