Mail in Order Form for Body Jewelry and Belly Button Rings Bodystuds
Printer Form for Mail Order

Please print clearly.

Customer Name:
Address:
City: State: Zip:
Day Phone: Eve. Phone: Fax: E-mail:
Qty	Item	Description	Price	Total
SUBTOTAL:
SALES TAX:			0
SHIPPING (USA ONLY):			$2.00
TOTAL AMOUNT:			$

PAYMENT INFORMATION

PAYMENT TYPE:* (Please select one.) Cash accepted NO C.O.D. accepted. money order payments accepted with postal mail orders ONLY.

Credit Card   Check**   Money Order

** Money orders only: Bodystuds CREDIT CARD PAYMENT INFORMATION:

TYPE OF CARD:*

Visa   MasterCard   American Express

CARD NUMBER:* (Must be 16 digits) EXP. DATE*

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CARDHOLDER'S NAME AS IT APPEARS ON THE CARD:*

CARDHOLDER'S SIGNATURE:* (Orders can not be processed without signature)