Costume Order Form

Fax: 425-392-1189

Choose Print from your browser menu. Fill out form and fax, email or drop off to Le Chic Pet. All information is required!

Name _________________________________________________________________________________

Address ___________________________________ City _______________________ St _____ Zip_______

Phone ____________________________________

Item #: ____________________________________ Size ___________ Color/Gender __________________

Qty. ________ Price $__________ x 9% Tax $ __________ = Total due (from table below) $_____________

Visa | Mastercard (circle one) _______________________________________________________________

Expiration ______________ 3-digit CVC Code ______________

Tax Table

I authorize the charges shown above, plus applicable shipping fee (not to exceed $4.95), to be charged to the card number provided. I further acknowledge this shipment will be delivered to Le Chic Pet Boutique and Spa and I will be notified upon arrival. Merchandise not picked up within 7 days of notification may be returned to sender. No refund will be issued for merchandise left at LCP for longer than 7 days after notification.

_________________________________________________________________

Cardholder Signature

Order deadline Oct. 15th