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PRINTABLE ORDER FORM

Date _____________________
First Name ________________ Last Name _______________________
Address __________________________________________________
City _______________________State _____________ Zip _________
Email Address ___________________ Telephone __________________
Check here if you would like a brochure sent to you.

Qty
Style #
Fabric Color
S - M - L
Ties or Velcro
Strap & Length

Price
Each
Total
             
             
             
             
             
             
             

Make check or Money Order
Payable to:
Lisa G.Tortoriello

Mail to:
Lisa G.Tortoriello
5465 NE 1st Terrace
Fort Lauderdale, FL 33334

  
Sub Total
  
 
Add 6% Sales Tax if in FL
  
 
Shipping( see info )
  
 
Add $10.00 if out of US
  
 
Total