PerfumersWorld

FAX MAIL ORDER FORM

Please send me: (Description of item(s) Select now or fill in after printing) 

Total in US$:.............................................. 

Cardholder Name:

Company Name:

Cardholder Address:

City:                                                                              State/Province:

Zip Code:                                                                      Country:

Phone No:                                   Fax: No:                                    Email:


Amount to be charged in US$ ........................ 

Please write the amount in words ........................................................................... 

Total in US$ will appear on your statement in Thai Baht. Please allow for currency fluctuations.

ENTER YOUR CARD DETAILS

 

CARD VALIDITY
THRU  MTH / YR

/ 
 
 

4 DIGIT No.
PRINTED ABOVE CARD No.

 
  

WRITE CARD NUMBER CLEARLY

 
 

Name as on Card:.............................................................................. 
 

 
 

Cardholder Signature: ....................................................Date:............ 
Please double-check your card details are correct. 

 
 

FAX THIS FORM AFTER COMPLETING YOUR ORDER DETAILS TO:  
In the USA:  (509) 561-6280  In the UK: (0845) 127-4926 
From other Countries International Access Code + 66 2 910 0126 
ALTERNATIVELY MAIL TO US: 
PerfumersWorld Ltd., 96/35 Prachachuen 37, Bangsue, Bangkok, Thailand. 10800. 
Or visit our showroom: PerfumersWorld, 120/1-2 Ngamwongwan Rd. Nonthaburi, Thailand. 11000. 
Allow up to 28 days for delivery