Order Form

This form is for Credit Cards (Visa, Mastercard, American Express & Discover!), Checks, Cash, Cashiers Check or Money Orders Only!! Print this form out and fill it out and mail it with your payment to the address below. PLEASE NOTE: that all checks must clear bank before your order will be shipped.

This form is for Credit Cards (Visa, Mastercard, American Express & Discover!), Checks, Cash, Cashiers Check or Money Orders Only!! Print this form out and fill it out and mail it with your payment to the address below. PLEASE NOTE: that all checks must clear bank before your order will be shipped. Or you can download the Order Form (.pdf format only).

SHIP TO: ____________________________

____________________________________

Phone #:___-_- E-Mail:____________________

Circle One: Credit Card - Check - Cash - Cashiers Check - Money Order

Credit Card #:--- Exp Date:-

Last 3 digits on back of card:_____

Qty Item # Description Total

_ ______ $_

Discounts $_________

Sub-Total $_________

California Residents Add Sales Tax (7.75%) $_________

Shipping & Handling Fees are FREE.

Order Total $_________

Please enclose check, cash, cashiers check or money order for the above amount, made payable to: Impressions By Lirica. Allow 2-4 weeks for delivery.

Mail order to:
Impressions By Lirica
P.O. Box 290717
Phelan, Ca. 92329-0717
Attn: Order Department

Copyright Š2000-2009 Impressions By Lirica Broom Shoppe
Nothing may be removed without express permission by the owner including graphics & content! International since 2003

Counter

Order Form

This form is for Credit Cards (Visa, Mastercard, American Express & Discover!), Checks, Cash, Cashiers Check or Money Orders Only!! Print this form out and fill it out and mail it with your payment to the address below. PLEASE NOTE: that all checks must clear bank before your order will be shipped.

SHIP TO: ____________________________

____________________________________

____________________________________

Phone #:_____-_____-______ E-Mail:________________________

Circle One: Credit Card - Check - Cash - Cashiers Check - Money Order

Credit Card #:______-______-______-______ Exp Date:____-____

Last 3 digits on back of card:_____

Qty Item # Description Total

____ _________ __________________ $_________

____ _________ __________________ $_________

____ _________ __________________ $_________

____ _________ __________________ $_________

____ _________ __________________ $_________

____ _________ __________________ $_________

Discounts $_________

Sub-Total $_________

California Residents Add Sales Tax (7.75%) $_________

Shipping & Handling Fees are FREE.

Order Total $_________

Please enclose check, cash, cashiers check or money order for the above amount, made payable to: Impressions By Lirica. Allow 2-4 weeks for delivery.

Mail order to:Impressions By LiricaP.O. Box 290717Phelan, Ca. 92329-0717Attn: Order Department

Phone #:___-_- E-Mail:____________________

Credit Card #:--- Exp Date:-

_ ______ $_

_ ______ $_

_ ______ $_

_ ______ $_

_ ______ $_

_ ______ $_

Mail order to:
Impressions By Lirica
P.O. Box 290717
Phelan, Ca. 92329-0717
Attn: Order Department