B-ANN

Beverly Hills Houston New York Paris

Printable Order Form

You also have the option of submitting your order via fax or mail.

To submit an order, please print this form and mail to:

B-ANN

Attn: Order Dept.

P.O. Box 440520

Houston, Texas 77244

All products ship within 24 hours after payment approval and confirmation.

Items Ordered:

Item Number	Item Title	Quantity	Price







Plus 8.25% sales tax (TX residents only)
UPS Shipping, (US dollars amount from shopping cart shipping total)
FedEx Overnight Shipping, please add: (US Dollars) $22.00
Total

For more items, please print and include a second form.

Customer Information

*First Name ________________________

*Last Name ________________________

Company ________________________

*Email ________________________

Phone _________________________

Credit Card Information

*Card Type ________________________

*Cardholder’s Name As Shown On Card ___________________________________

*Card Number ______________________

*Expiration Date (mmyy) ____ / ____

*3 Digit Security Code _______________

*Required fields.

Billing Address

*Address Line 1 ______________________

*City _______________________________

*State/Province _______________________

*Country _____________________________

*Zip/Postal Code ______________________

Shipping Address (if different from billing address)

Ship To Name __________________________

Address Line 1 __________________________

City __________________________________

State/Province __________________________

Country _______________________________

Zip/Postal Code _________________________

Thank you for ordering from B-ANN . If you have any questions, please do not hesitate to contact us by email at: info@b-ann.com