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Decor and Gift - Decor Order Form (Page 1)

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Decor and Gift - Decor Order Form
P.O. Box 222
Fountain City, WI 55629
Phone and Fax: (608) 687-4299
Email: info@decorandgiftshopping.com
Billing Information
[The name, address, and contact information of the person who is paying for the items in this order]
Name
Address
City/State/Zip
Country
Telephone
E-mail
Shipping Information
[The name, address, and contact information of the person who we should ship the item to - leave
blank if same as billing information]
Name
Address
City/State/Zip
Country
Telephone
E-mail
Decor and Gift Accepts Visa, Mastercard, and Discover
[If you are paying by credit card, provide the information exactly as it appears on your credit card]
Name on card
Card Type (V/M/D)
Card number
Expiration date
Validation code *
* The validation code is the last three digits that appear on the signature strip of your card (Master
Card and Visa only).
Signature of card-holder ( required ): ___________________________________________________

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