BICHON BOUTIQUE ORDER FORM

If paying by VISA or MasterCard, print this form, fill out, and fax to Jill at 301-762-6422. If no fax available, charge orders may be phoned in to 301-762-6022 between noon - 9 PM Eastern time. If paying by check or money order, print and complete this form and mail with payment. Make checks payable to MARYLAND BICHON FRISE RESCUE, INC. and mail to MBFR - Jill Siegel / 13400 Valley Dr. / Rockville, MD 20850. Orders paid by personal check will be processed after check clears.

If you want your item shipped to an address other than the one at top of form, put the BILLING ADDRESS in the top portion, and the SHIP TO address at the bottom under Special Instructions. Thank you!

Name on Check
or Credit Card
Address
City, State, ZIP
Daytime Phone
Email Address
Form of Payment: VISA ____ MasterCard ____ Check/Money Order____
Credit Card #
Please don't use a BUSINESS CREDIT CARD (fees are DOUBLE for them)
Expiration Date (mm/yyyy)
CVV2/CVC2/CID
3-digit # on back of card

ORDER - If need more space, write additional items under Special Instructions or on separate paper

Quant.
Item Name
Size Color Item # Price
Shipping
 Total Cost
          $ $  $
          $  $  $
          $  $  $
          $  $  $

Merchandise Total:   _________

6% Sales Tax (on Maryland orders only; no tax charged on shipping): _________

TOTAL PAYMENT :   __________

Special Instructions


 

Thank you very much for your order!
* 100% of the profits go to Bichon Rescue to help bichons in crisis *