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 your 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.
  • Return Policy: Please see our policy here
YOUR ADDRESS
Name:

BILLING Address:



 City, State, ZIP:

SHIPPING Address:



City, State, ZIP:
Phone:


 Email:
Show Coming Up? When?

ITEM COLOR SIZE FABRIC PRICE






























SHIPPING CHARGES:
Please see our current shipping rates here

10% discount for orders + $200, 15% for orders + $350
Review our Return Policy here before ordering.
See our rush info here.

Thank You for Your Order!

Subtotal  
Discount (if any)  
Shipping (see chart)  
CA Res. add 7.25%  
TOTAL ENCLOSED

CREDIT CARD INFORMATION
We accept Visa, Mastercard, American Express and PayPal - please see ordering instructions here.
Card Number: Expiration Date:
Security Code: Signature:
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