Order Form

 

Print out the order form below and send with your check, money order or credit card info to:
 Bucio Lingerie | P.O. Box 811464 | Chicago, Illinois  60681
Checks/Money Orders are deposited upon receipt. Returned checks are subject to a service charge for the maximum amount allowed by state law. Please add 10.25% for Illinois deliveries.
 


Order Form

P.O. Box 811464
Chicago, Illinois  60681

Ordered By:

Name:_________________________________

Address:_______________________________

City, State, Zip:_________________________

Area Code,
Telephone:_____________________

Ship To: (if different)

Name:_________________________________

Address:_______________________________

City, State, Zip:_________________________

Area Code,
Telephone:_____________________

Style #

Qty.

Description of Item

Size

1st Color Choice

2nd Color Choice

Unit Price

Total
               
               
               
               
               
               
               
               
               

CREDIT CARD PAYMENT: (Please circle)

amex.gif (407 bytes)     visa.gif (427 bytes)      discover.gif (749 bytes)     mastercard.gif (1952 bytes)
________________________|__________
    Credit Card Number   Exp. Date

__________________________________
Signature

Postage and Packaging

If Your Order Totals:

     Up to $10.00      Add  - $4.95
     $10.01 -  $25.00      Add  - $6.50
     $25.01 -  $35.00      Add  - $7.95
     $35.01 -  $50.00      Add  - $8.95
     $50.01 -  $65.00      Add  - $10.50
     $65.01 -  $75.00      Add  - $11.95
     $75.01 -  $105.00      Add  - $12.95
     $105.01 - $150.00      Add  - $14.95
     Over $150.00      Add  - $16.50
Merchandise Subtotal  $ 
Illinois Deliveries
Add 10.25% Sales Tax 
$

Postage and Packaging
 



$

 

 
Total Amount Enclosed $

 

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