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FAX FORM - NAME BRAND WIGS

Fax Order Form
Please fax order to 320 685 9809

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.