Please print this form and enclosed with your order.
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CHECKS & MONEY ORDERS PAYMENTS
CUSTOMER'S FIRST & LAST NAME
BILLING ADDRESS
SUITE OR APT #:
AREA CODE & PHONE NUMBER
CITY:
STATE:
ZIP:
IS SHIPPING DIFFERENT THAN BILLING ADDRESS?
NO
YES, PLEASE COMPLETE SHIPPING FORM BELOW
SHIPPING ADDRESS
PERSON'S FIRST & LAST NAME
COMPANY'S NAME
ADDRESS:
SUITE OR APT.#
CITY:
STATE:
ZIP:
ITEM #
COST:
ITEM#
COST:
ITEM#:
COST:
YOUR EMAIL ADDRESS:
PLEASE DO NOTE SEND CHECK OR MONEY ORDER PAYMENT UNTIL YOU RECEIVE AN EMAIL FROM DIVINE DIVAZ'S OF YOUR ORDER WITH TAX & SHIPPING CHARGES INCLUDED
.
*ITEMS WILL NOT BE SHIPPED UNTIL CHECK OR MONEY ORDER HAS CLEARED.
