BelilahOnline Printable Order Form
(Use the "Print" function in your browser)
Customer Information: (please print)
Name: ___________________________________________________________
Shipping Address: __________________________________________________
City, State, Zip: ____________________________________________________
e-mail address: ____________________________________________________
Item
Number |
Item
Name |
Notes (color, measurements etc. when applicable) |
Price
Each |
Quantity | Total
Price |
Subtotal
|
|||||
Shipping (see the Shipping
Terms page) |
|||||
Total
|
Checks or Money Orders should be payable to BelilahOnline and should be mailed to:
BelilahOnline.com
P.O. Box 281
Lexington AL 35648