URSULA'S COSTUMES

Fax/Mail Order Form
Print out this page and fill it in as you browse the site,  Then fax it to (310) 582-8233
Or call in your order (310) 582-8230
Have your Credit Card ready for the fastest service!
Please be sure to print legibly and check your order for accuracy.
Shipping Information
Name  
Street Address  
City, State, Zip, Country  
Phone Number  
E-mail Address  
Order Information
Item Number Description Size Quantity Unit Price Total
           
           
           
           
           
           
           

Sub-Total:  

  
If you are a California Resident, please calculate 8.25% sales tax    
* Shipping Charge: (Please check the chart below for the proper amount to add)    
(Please pay this amount) GRAND TOTAL:    
Credit Card Information
Check one   American Express   Discover Card   MasterCard   Visa
Name on Card:  
Credit Card Number:  
Expiration Date:  
Signature:  
If your Sub-Total is less than or up to $20.00, add $8.00
If your Sub-Total is between $20.01 to $40.00, add $9.00
If your Sub-Total is between $40.01 to $60.00, add $10.00
If your Sub-Total is between $60.01 to $80.00, add $11.00
If your Sub-Total is between $80.01 to $100.00, add $12.00
If your Sub-Total is more than $100.00, add $13.00
Each additional $100.00, add $2.00
For Hawaii and Alaska, add additional $12.00

PLEASE PRINT THIS PAGE AND MAKE SURE THAT THERE ARE NO BLANK FIELDS BEFORE SENDING.

PLEASE FAX ORDERS TO: (310) 582-8233
OR CALL IN YOUR ORDER: (310) 582-8230

* IF MAILING A MONEY ORDER OR CASHIER'S CHECK 
PLEASE MAKE IT PAYABLE  TO "URSULA'S COSTUMES"

OUR MAILING ADDRESS IS:

Ursula's Costumes Inc.
2516 Wilshire Blvd.
Santa Monica, CA 90403

* (Please allow one to two weeks to receive your order.)

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