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Order By Mail: |
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| 24 hrs/day 7 days/week |
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Comfort Scrubs |
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1018 Industrial Drive |
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Hazlehurst, MS 39083 |
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SHIP TO ADDRESS:
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MAILING ADDRESS
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(if different from
shipping)
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Name: _____________________
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Name: ____________________
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Street: ____________________
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Street: ____________________
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City: ______________________
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City: ______________________
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State/Zip: __________________
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State/Zip: __________________
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Phone #: (_____)-____________
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Phone #: (_____)____________
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Fax #: (____)-_______________
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Fax #: (____)_______________
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Item # and Description
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Color
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Size
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Quantity
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Price Each
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Total
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| ___ Check ___ Purchase Order ___ Money Order |
Subtotal:
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___ Visa ___ Discover ___ MasterCard ___ Amex
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Sales Tax:
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Card #: ___________________ Exp. Date: _________
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Shipping/handling:
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Signature (required for all cards):
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Grand Total:
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_____________________________
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Shipping Method: (circle one) UPS Ground UPS 3 Day Select UPS 2nd Day Air
UPS Next Day Air
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| Your email address: _________________________________ |
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| How did you find out site? (circle one) |
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| Yahoo Excite InfoSeek Google Other ____________________ |
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| Please email us with any suggestions on fabrics, items, or sizes that you would like to see on our website. |
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