Plus Lady Inc.
125 East Kings Highway - Haddonfield,  New Jersey  08033 
Phone - 856-354-1917 Fax - 856-354-1929
Please print this form for sending orders by MAIL or by FAX ONLY
Date _____________
#1 - BILL TO: #2 - SHIP TO:

Credit card customers must indicate address where statements are received

If different than BILL TO
Name:_____________________________
Company:__________________________
Address:___________________________
City:______________________________
State:
_______
Zip Code:
_____________
Daytime Phone:
______________________
Evening Phone:
______________________
Name:_____________________________
Company:__________________________
Address:___________________________
City:______________________________
State:
_______
Zip Code:
_____________
Daytime Phone:
______________________
Evening Phone:
______________________
#3 - METHOD OF PAYMENT 
#4 - E-MAIL ADDRESS:  
(Please check one of the boxes below)
___________________________________@________________________________
COD
VISA
MC
If you wish to FAX your order please
FAX it to 856-354-1929
If you wish to mail the order please mail
it to the above address.
This order form is for MAIL ORDERS
or
FAX ORDERS only
 
DISCOVER
OTHER
 
Card #: _________________________________________
Exp Date: ________/________/________
#5 - SIGNATURE:
X: ________________________________________
With this signature I authorize Plus Lady to charge
my card for this order.
#6 - ITEMS ORDERED
QTY
STYLE #
PRODUCT NAME
COLOR
SIZE
EACH
TOTAL
          $ $
          $ $
          $ $
          $ $
          $ $
          $ $
          $ $
          $ $
          $ $
#7 - TOTAL MERCHANDISE:
 $
#8 - GRAND TOTAL:
 $