Wild Rose China Co. Order Form
You may snail Mail or email us your order in addition to our convenient on-line store.
To submit an order, please print this form and mail to:
Flying Dollar Enterprises
Wild Rose China
31218 N. 232 Ave
Wittmann, AZ 85361
Phone Order's To: 623-388-0596
Please send us an email if you sent an order by email.
Items Ordered:
|
Item Number
|
Item Title
|
Date |
Pattern Name
|
Quantity
|
Price
|
|
e.g. 00125-01
|
Teapot |
|
Aurora
|
e.g. 1
|
e.g. 14.95
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Arizona Residents must pay 6.2 % Tax
|
|
|
|
|
|
Shipping is calculated based on your order total
|
|
|
Total
|
|
For more items, please print and include a second form.
|
Customer Information
*First Name ________________________
*Last Name ________________________
Company ________________________
*Email ________________________
Phone _________________________
Credit Card Information
*Card Type ________________________
*Cardholder’s Name As Shown On Card ___________________________________
*Card Number ______________________
*Expiration Date (mmyy) ____ / ____
*3 Digit Security Code _______________
*Required fields.
|
Billing Address
*Address Line 1 ______________________
*City _______________________________
*State/Province _______________________
*Country _____________________________
*Zip/Postal Code ______________________
Shipping Address (if different from billing address)
Ship To Name __________________________
Address Line 1 __________________________
City __________________________________
State/Province __________________________
Country _______________________________
Zip/Postal Code _________________________
|
Thank you for ordering from Wild Rose China Co. If you have any questions, please do not hesitate to contact us by phone at: 623-388-0596, or by email at: flyingdollar@gmail.com
