L. Rose Designs Printable Order Form
5610 West End Road, Suite 103, Arcata CA 95521
- Phone/Fax: (707) 825-7759 - lrose@lrosedesigns.com -
  • To place an order, print this form and mail with credit card information or send check/money order made to L. Rose Designs. Do not email credit card information! You may also call in orders at (707) 825-7759 10am-5pm (Pacific Time) Mon-Fri, or fax anytime to the same number.
  • Your order is custom made for you. Please allow at least 3-4 weeks for delivery. Rush charges apply for orders needed within 3 weeks of order date.
YOUR ADDRESS
Name:
BILLING Address:

City, State, ZIP:
SHIPPING Address:

City, State, ZIP:
Phone: Email:
>>> PERFORMANCE DATE:

ITEM COLOR SIZE FABRIC PRICE






























SHIPPING CHARGES:
$0.00 - $50.00 = $8.00 |||| $50.01 - $100.00 = $10.00
$100.01 - $200.00 = $12.00 |||| $200.01 - $350.00 = $16.00
Troupe, Large, International and Expedited
orders will be charged exact shipping.

10% off orders over $200, 15% off orders over $350
Review our Return Policy before ordering.
Review our Rush Policy if needed quickly!

Thank You for Your Order!

Subtotal  
Discount (if any)  
Shipping (see chart)  
CA Res. sales tax (please contact us for your tax rate)  
TOTAL ENCLOSED

CREDIT CARD INFORMATION We accept Visa, Mastercard, & American Express.
If you'd prefer PayPal, please check here: ______ (and be sure to give us your email address)
Card Number: Do not include if emailing form! Expiration Date:
Security Code: Signature:
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