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 |