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