Order Form
Order Form
Date:.........................
Name:...................................................
Address:...........................City:....................State:.....Zip:.....
Telephone number:........................
e-mail address:............................
Backless Tops
Quantity:.......Style: Bra Front.... Sinch front....
Color......................
Quantity:.......Style: Bra Front.... Sinch front....
Color......................
Quantity:.......Style: Bra Front.... Sinch front....
Color......................
Quantity:.......Style: Bra Front.... Sinch front....
Color......................
Backless Top $28. each.......................
+Shipping $3..............................
orders over 3 Qty. $1. each...........................
Total $......................................
Make check payable to: Elaine DeRosa
Mail to: Elaine's Originals
29 Rancho Road
Tustin, CA. 92780