MIME-Version: 1.0 Content-Location: file:///C:/07A4468D/FAXFORM.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" HEARTS DESIRE GIFTS FAX FORM

HEARTS DESI= RE GIFTS

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PRINT THIS FORM and Fax to 817-275-1080<= /o:p>

You must call us before faxin= g so we can turn our fax machine on

ITEM NO.

       &nbs= p;           Item Name / Description

QTY

PRICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I would like to = pay by:  (Check One)    (WE DO NOT ACCEPT PERSONAL CHECKS)<= o:p>

    ___VISA    ___MasterCard   ___ American Express   ___DISCOVER   ___PAYPAL<= /b>

    ___U.S. Postal MONEY ORDER    ___ Cashier= 's Checks

   CARDHOLDER NAME _____________________________________________

        =             &nb= sp;            =         (Exactly as shown on Card)    =

Cr= edit Card Number __________________________________= __

Ex= piration Date      Month: ________    Year: ____________

BILLING ADDRESS (Must match Credit Card Billing Address):

Name=     _________________________________________

Address _________________________________________

&nbs= p; _________________________________________

City=        _______________________________= __________

State     _______________   ZIP CODE _______________ 

 

SHIP TO ADDRESS (If different from above)  If same, please write in "Same"

Name=     _________________________________________

Address _________________________________________

&nbs= p; _________________________________________

City=        _______________________________= __________

State     _______________   ZIP CODE _______________ 

EM= AIL ADDRESS      ____________________________________

PH= ONE NUMBER      ___________= __________________________

We must have your email address and phone number to confirm your order.

We will confim your order by e-mail within 48 hours.