Please fill in the info about yourself below, pint this form and mail it to us.
Mail address:
"IRINA DESIGN" 921 Regency Rd. Danville, KY 40422
First Name:
Last Name:
Address:
Street:
City:
State/Province:
ZIP/Postal code:
Country:
Phone:
E-mail:
Items you are buying:
ITEM ID:
ITEM NAME:
PRICE:
COMMENTS:
Shipping & Handling 3% /minimum $10.00/
KY residence sale tax 6% if applicable
TOTAL:
Method of payment choose one please:
Check
Money Order
Credit Card
If you selected a credit card payment please fill out following information
Credit Card:
Credit Card Number:
Expiration Date:
Please allow one week for delivery unless previous arrangements are made.
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