MONEY-ORDER / CASHIERS-CHECK ORDER FORM

Enter data on this page, print, and send with the check to:
 THE ROSE DRESS,    741 CHARCOT AVENUE, SAN JOSE, CA. 95131

Name

 *(first) *(last)

Phone Number

 * 2nd Phone#

E-mail Address

 * (double check)

Shipping Address

 

Item numbers start with 2 letters followed by numbers/letters 
(ex. FI 1116)
Item1 # Color Size Price:$
Item2 # Color Size Price:$
Item3 # Color Size Price:$
Item4 # Color Size Price:$
Item5 # Color Size Price:$

To order more than 5 items, please use the Instructions Text Box below.
add 8.25% tax for California customers.

Please choose one: amount shown is for one item.
Date of the Event: (optional)      
Cancel order if not received by this date: (optional)
 

( Use the Text Box below to add more items.
Include Item#, Size, Color, & Price )

(optional)
Consider having a second choice in case first choice is not available.
Indicate second or third choice using text box below.


Instructions/
Add Items/
2nd choice/
Questions/