Georgia's Furs FAX Order Form

To order, please print this form, clearly fill out the information below and fax it to us at:
(856) 354-2184

Style number to order: ____________

Color: ____________

Name:__________________________________________

E-mail:__________________________________________

Street Address:___________________________________

Address2:________________________________________

City:____________________ State:_____ Zip:__________

Phone #:_________________________________________

Size:___________ Height:__________Weight:___________

�� Payment Information:

Credit Card Type:_____________________________________

Credit Card Number:___________________________________

Expiration Date:_______________________________________

Our staff will contact you at the telephone number listed above 
to confirm your information and answer any questions. 
Thank you for your order!

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