Laurance Clothing Faxable Order Form

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232 Main Street * Annapolis, Maryland 21401-2005 * Tel 410.263.1175
* Fax 410.263.1176

Date:__________________

Sold to:

Name:______________________________ Company Name:_______________________________

Address:________________________________________________ Apt. # ___________________

City:______________________________________ State:_____________ Zip:_________________

Phone # _____________________________ Fax #_______________________________________

Send to:

Name:______________________________ Company Name:_______________________________

Address:________________________________________________ Apt. # ___________________

City:______________________________________ State:_____________ Zip:_________________

Phone # _____________________________ Fax #_______________________________________

Item # Quantity Description ColorPrice Total

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

TOTAL: _________________

SHIPPING: $10.00

MD Residents add 6% tax _________________

TOTAL DUE: _________________

Method of Payment: Sorry, no COD's

Check/Money Order____ Visa____ Master Card ___ American Express ____

Card Number:___________________________________ Expiration Date: _____________________

Signature:_______________________________________

Please allow 2 weeks for delivery.

use our printer-friendly fax form