BlackLine
 
ORDER FORM
 
Phone: BlackLine   Date: BlackLine
Email: BlackLine  
 
CREDIT CARD BILLING ADDRESS   SHIPPING ADDRESS
     
BlackLine WhiteLine BlackLine
     
BlackLine WhiteLine BlackLine
     
BlackLine WhiteLine BlackLine
     
BlackLine WhiteLine BlackLine
 
CREDIT CARD INFORMATION
 
Credit Card Type:    CheckBox VISA    CheckBox MasterCard    CheckBox Discover    CheckBox American Express
Card Number: BlackLine
Expiration Date: BlackLine   CVV2 Number: BlackLine
Your Signature: BlackLine
 
Quantity Item Description Color Size Item Price Extended
             
             
             
             
             
             
             
             
             
             
             
             
             
             
CheckBox Ship by USPS Priority Mail $6.95 Cont US Only
CheckBox Ship by USPS Express Mail $22.95 Cont US Only
CheckBox Ship by USPS Global Express Mail $27.95 Int'l Only
CheckBox Ship by UPS Ground $16.50 Cont US Only
CheckBox Ship By UPS Next Day Air $75.50 Cont US Only
CheckBox Ship by UPS World Wide Expedited $155.50 Int'l Only
I. Item Sub Total  
II. Shipping Charge  
III. Order Sub Total (I + II)  
IV. Sales Tax (GA Only, 6% of III)  
V. Order Total (III + IV)  
 
BlackLine
TheLingerieConnection.net   5885 Cumming Hwy Suite 108-358 Sugar Hill, GA 30518 Phone: 877.852.7355 FAX: 866.904.6533