FAX FORM - NAME BRAND WIGS – NameBrandWigs.com

Fax Order Form
Please fax order to 320 685 7100

Customer Information
Customer Name	________________________________________________
Ship to Street Address	________________________________________________
City	________________________________________________
State / Zip	________________________________________________
Email address	________________________________________________
Phone number	________________________________________________

Item Information
Wig Name	________________________________________________
Wig Brand	________________________________________________
Wig Color	________________________________________________
Wig Quantity	________________________________________________

Payment Information
Name on Credit Card	________________________________________________
Billing Street Address	________________________________________________
City	________________________________________________
State / Zip	________________________________________________

Credit Card Type	Visa / MasterCard / Discover / American Express (Circle One)
Card Number	________________________________________________
Expiration Date	________________________________________________

Signature	________________________________________________
	By signing above, you are authorizing Name Brand Wigs parent company Joshua24.com to charge your credit card for the products ordered plus shipping and handling charges.

FAX FORM - NAME BRAND WIGS