Ascanty.com Hosiery

Fax ORDER FORM
Page Lingerie & Accessories
21 Paramount Ave.
Escondido, CA 92027
Fax (760-839-8221)
Fill out and Print-out for Mailing or Fax 
Name:   
Credit Card Billing Address:
City:    
State:  
Zip:    
Phone:  
E-Mail:  (Required)
THE EXACT NAME & BILLING ADDRESS OF THE CREDIT CARD YOU ARE USING IS REQUIRED
How will you be paying?
Card Number:Expire Date:
Where Will Your Order Be Shipped To? United States Canada or Mexico All Other Countries 
Additional Comments or Information:
Style # & Name: Size:Color: 
Quantity: Price:Total: 
Style # & Name: Size: Color: 
Quantity: Price:Total: 
Style # & Name: Size:Color: 
Quantity: Price:Total: 
Style # & Name: Size: Color: 
Quantity: Price:Total: 
Style # & Name: Size: Color: 
Quantity: Price:Total: 
Style # & Name: Size: Color: 
Quantity: Price:Total:  
Total Items Ordered:            

Total Cost:                     

Calif. Sales Tax .0775%         

Shipping Charge:                

Total:                          
Print this Form Out and Print for Mail or Fax
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Fax: (760) 839-8221
 Mail to and make Money Orders to: 
Page Lingerie & Accessories
21 Paramount Ave.
Escondido, CA 92027


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