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Printable order form for shopping by FAX or Mail
dive goddess
6721 Brants Lane
Fort Worth, TX 76116
(817) 569-9669 - Phone
(817) 738-0440 - Fax
Order Date
Ship Date
CVC
(3 digit # on back of card)
Visa or Mastercard Number (We are unable to accept debit cards.)
Card #
Exp. Date
Authorized Signature
Billing address must match credit card billing address.
Name
Address
City
State
Post Code
Country
Phone
Email
Shipping Address
If different from Billing
Name
Address
City
State
Post Code
Country
Phone
Email
Qty.
Fabric #
Size
Fabric Name - Item
Unit Price
Total (US $)
Shipping & Handling
TX Residents Add 8.25% Sales Tax
Total (US Currency)
