For FAX or mail orders  Print this form

For payment by: Check, Money Order or Credit card

Brigitewear  Order Form

Shipping Address if different:

Name:

Name:

Address:

(Billing) Address:

Address:

Address line 2:

City:

City:

State/Province.:

State/Prov:

Country:                                 Postal code/Zip code:

Country:

Phone:

Zip, Postal code:

Email:

Phone:

Credit Card Number

Expiration Date

Signature:

 Product Name

Quantity

Top

Size

Bottom

Size

1 Piece

Size

Color

Total Price

Sub Total

*Shipping Information:

Free Standard Shipping on orders over $60.00

(International orders allow 3 -6 days additional on all shipping methods)

Cost

Your may FAX your credit card order toll free to the number below:

1-866-424-6129

 If paying by check or money order, make payable to:

Brigitewear International

(allow 7 days for personal checks to clear)

Sales Tax (California only  add 7.8%)

Standard (orders under $50)

Allow 6-8 business days

 $ 5.95

Add

*Shipping

 Priority U.S.

International

3-5 business days

7-15 business days

 $9.95

$16.95

Total

 Rush (U.S. only)

 1-3 business days must have Phone number no PO Boxes

$23.95