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TO: BRIDAL BRIDALS
200 Fulton Street
Farmingdale, N.Y. 11735
PHONE: (516) 249-3005 FAX (516) 931-0500

This is to authorize you to charge my credit card for the merchandise ordered below . The information on my credit card is as follows:

NAME (on card)_________________________________________EXP Date :__________________


NUMBER:__________________________________________________________________________


Merchandise ordered is as follows:



ITEM:_____________________________ MANUFACTURER________________________


STYLE #_________________SIZE:_________________COLOR:_________________
(List additional items on a seperate sheet, but put total charges on this sheet- Thank You.)


Magazine Name:__________________________Issue Date:____________Page #____________



Location on page if more than one item shown:________________ center, right, left, Attach picture.


.....$25.00 for regular UPS; $10.00 for each change of address.....
Must be signed by person whose name is on the credit card
Phone number of person signing authorization _____________________


Merchandise to be shipped to:




I understand all sales are final and no exchanges, refunds, or cancellations are allowed. Should any item be received with a manufactures defect, the item will be replaces or repaired promptly. Make sure the correct size is ordered. WHEN POSSIBLE INCLUDE A PICTURE AND?OR A DESCRIPTION OF THE ITEMS BEING ORDERED. Sales tax is NOT charged unless merchandise is shipped to a New York address.


SIGNATURE OF PERSON ORDERING_________________________________


DAY PHONE_______________________________ EVE PHONE________________________________


............Name...................Bust...............Waist.............Hip........Usual dress size...........Barefoot Height


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............Name...................Bust...............Waist.............Hip........Usual dress size...........Barefoot Height


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FOR OFFICE USE ONLY

DATE____________ # OF PAGES___________

TO____________________________FROM___________________________
co/dept________________________Co______________________________
Phone_________________________phone___________________________
Fax___________________________Fax_____________________________

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