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