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 = $7.00 |||| $50.01 - $100.00 = $9.00
 $100.01 - $200.00 = $11.00 |||| $200.01 - $350.00 = $15.00
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. add 9%  
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: Expiration Date:
Security Code: Signature:
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