Your Complete Source for Prom, Bridal, Pageant, Social Occasion and Fashion Jewelry, Pins and Tiaras

Atlanta Apparel Mart, Suite 7S-115A 250 Spring Street Atlanta, Georgia 30303 Phone: 404-586-0045, 877-727-7900 Email: Sales@SassySouth.com www.SassySouth.com FAX 404-688-2462

FAX ORDER FORM Date: ______________________

CUSTOMER INFORMATION	SHIP To (If different address)
Store Name: _________________________ Street Address: ______________________ City, State, Zip: ______________________ Email: ______________________________ Phone #: ____________________________ Fax #: ______________________________ Contact Name: _______________________	Store Name: __________________________ Street Address: ________________________ City, State, Zip: ________________________ Contact Name: ________________________ Phone #: _____________________________ Fax #: _______________________________

Quantity	Style #	Description/Color	Price Ea.	Total
			Total:

Method of Payment:

__ COD Certified  __ Net 30 __ COD Company Check

__Visa __MC __AMEX ______________________________ Exp ___/___ Card Holder Name: _______________________

Please Note: Items ordered without style # will not be authorized for return if incorrect.

Office Use: Customer had all style numbers for order: Yes __ No __ Order Taken By: