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Text File  |  1996-08-09  |  5KB  |  128 lines
  1. Page 1/2                 NYSTYLE FAX ORDER FORM
  2.  
  3. Fill out this form and fax or mail to:
  4.  
  5. NYSTYLE, Inc., 300 West 12th St, Suite 3I, NY,NY,10014
  6.  
  7. To:   NYSTYLE
  8.  
  9. Fax:  1.212.741.2640          Tel: 1.212.633.0165
  10. ____________________________________________________________________
  11.  
  12. From: ______________________    Date:_______________________________
  13.  
  14. Fax:  ______________________    Tel: _______________________________
  15.  
  16. ____________________________________________________________________
  17.  
  18. Member ID:(current members) ________________________________________
  19.  
  20. BILL TO INFORMATION:
  21.  
  22. Name:_______________________________________________________________
  23.  
  24. Company:____________________________________________________________
  25.  
  26. Address:____________________________________________________________
  27.  
  28. City:___________________  State:______   Zip Code: _________________
  29.  
  30. Telephone: Day:(______)__________________ Eve: (____)_______________
  31.  
  32. Fax #:(_____)_____________________  Country:________________________
  33.  
  34. SHIP TO INFORMATION: (if different from Bill To e.g. a gift)
  35.  
  36. Name:_______________________________________________________________
  37.  
  38. Company:____________________________________________________________
  39.  
  40. Address:____________________________________________________________
  41.  
  42. City:___________________  State:______   Zip Code: _________________
  43.  
  44. Country:____________________________________________________________
  45.  
  46.  
  47. Your email address: (reqd):_________________________________________
  48.  
  49. CREDIT/PAYMENT INFORMATION
  50.  
  51. Payment Type:___ Amex ___Visa ___ Mastercard ___Check ___Money Order
  52.  
  53. Credit Card Number: ________________________________________________
  54.  
  55. Name on card: ______________________________________________________
  56.  
  57. Expiration date: ___________________________________________________
  58.  
  59.  
  60. ____________________________________________________________________
  61.  
  62.  
  63.  
  64.  
  65.  
  66.  
  67.  
  68.  
  69. Page 2/2                         ORDER DETAILS
  70.                                  -------------
  71. ____________________________________________________________________
  72. ORDER DETAILS:
  73.  
  74. If this is a gift, please enter your message below:
  75.  
  76.  
  77.  
  78. ____________________________________________________________________
  79.  
  80. If the item to order requires additional choices or customized options,
  81. enter these in the Description/Options box.
  82. ___________________________________________________________________________
  83.  
  84. Qty   Product#   Description/    Color   Size  Price   Shipping Total
  85.                  Options
  86. ___________________________________________________________________________
  87.      |       |                  |      |      |      |         |
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  90.      |       |                  |      |      |      |         |
  91. _____|_______|__________________|______|______|______|_________|___________
  92.      |       |                  |      |      |      |         |
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  96. _____|_______|__________________|______|______|______|_________|___________
  97.      |       |                  |      |      |      |         |
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  101. _____|_______|__________________|______|______|______|_________|___________
  102.      |       |                  |      |      |      |         |
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  105.      |       |                  |      |      |      |         |
  106. _____|_______|__________________|______|______|______|_________|___________
  107.      |       |                  |      |      |      |         |
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  111. _____|_______|__________________|______|______|______|_________|___________
  112.      |       |                  |      |      |      |         |
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  116. _____|_______|__________________|______|______|______|_________|___________
  117.  
  118.  
  119.                         TOTALS         |___________
  120.                         TAX (NY-ONLY 
  121.                         x 8.25%)       |___________
  122.  
  123.                                                 GRAND TOTAL    |___________
  124.  
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  128.