Martha's Leg Fashions

Order Form

Your Contact Information
Name, Address, Email and Phone are REQUIRED.

Name:

Street Address:

City/State/Zip:

Email: Phone:

Shipping Address: (if different from above)

ITEM #1

MFG:	STYLE:	COLOR:	SIZE:
DESCRIPTION:		QTY:	PRICE:

ITEM #2

MFG:	STYLE:	COLOR:	SIZE:
DESCRIPTION:		QTY:	PRICE:

ITEM #3

MFG:	STYLE:	COLOR:	SIZE:
DESCRIPTION:		QTY:	PRICE:

ITEM #4

MFG:	STYLE:	COLOR:	SIZE:
DESCRIPTION:		QTY:	PRICE:

ITEM #5

MFG:	STYLE:	COLOR:	SIZE:
DESCRIPTION:		QTY:	PRICE:

Please note that SHIPPING CHARGES will be added.
SALES TAX will also be added to orders shipped within California.

Payment Information:

Cardholder Name:

MasterCard or Visa?

MasterCard

Visa

Credit Card Number:

Expiration Date:

CVV Code: 3-digit code on back of card

Credit Card Billing Address: (if different from Contact Information above)

ADDITIONAL COMMENTS/INSTRUCTIONS:

PRINTABLE ORDER FORM:
If you would rather print out a form and FAX it to Martha's Leg Fashions (818) 758-2240,
or MAIL it with your check, you can do so by downloading the printable order form here:
Download Order Form Here

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