Accessorybiz.com - (DBA: Fancy Fashion Jewelry)
Fax Order Form

Fax: 1-323-375-1649

Item#	Category	Quantity	Price	Total
Please note: $100.00 minimum purchases for US customers.
Price Total:

Customer Information

Company Name / Name:

Address:

City, State, Postcode / Zip:

Reseller’s Permit Number:

E mail address ( required ) :

Phone Number:

Fax Number:

Payment Method (please check one)
___MasterCard	Exp. Date:	Account#:
___Visa	Exp. Date:	Account#:
___American Express	Exp. Date:	Account#:
Name
Address:
City, State:
Postcode / Zip:
Signature (required for Fax orders):
Comments/Instructions(example: Different shipping address):

Accessorybiz.com - (DBA: Fancy Fashion Jewelry)

4055 Wilshire Blvd., Suite #221
Los Angeles, CA 90010
Tel: 1-213-386-5659
Fax: 1-323-375-1649