Arizona Twists and Curls

Printable Mail or Fax Order Form

(We accept Visa, Mastercard, Amex, Discover, Money Order and Cashier's Checks)

Make all payments payable to: Mark Gillo

P.O. Box 283  •  Chino Valley Arizona  •  86323  •  Phone: 928.710.4182  •  Fax: 928.583.0875
Date: ________________

BILL TO: SHIP TO:    (if different from billing address)
Name: Name:
Address: Address:
City/State/Zip: City/State/Zip:
Phone #: Phone #:
Email:  

Item Number

Item Description

Qty

Price

Total

         
         
         
         
         

Sub-Total: ____________
Sales Tax (Arizona residents add 7.5%): ____________
Shipping: ____________
GRAND TOTAL: ____________
Credit Card Information (choose one)
Visa      Mastercard      American Express      Discover

Credit Card #: Expiration date:
Thank you for shopping at "Twists and Curls".
Home Page: www.TwistsandCurls.com