NOTE: You may place your wholesale order by emailing us the following information below at info@fashionmine.com. If you would like to fax this form, you may Copy (Ctrl + C) and Paste (Ctrl + V) the following information below in Word document, type in all required information under Contact Information, Billing Information, Shipping Information, Style Number, Color, Quantity, Price, and print out a copy by pressing Ctrl + P, or go to File and click on Print on the upper left hand corner of your internet browser window. After you have printed out a copy of this order form, please fill out in black or blue ink pen the following information below. You may fax your order to us at 213-629-4626. Thank You.
Contact Information
Email Address:
Business Phone:
Mobile Phone:
Billing Information
Company Name:
First Name:
Middle Name:
Last Name:
Billing Phone Number:
Billing Address 1:
Billing Address 2:
Billing City:
Billing State:
Billing Zip Code:
Credit Card Number:
Credit Card Type:
Expiration Date (MM/YYYY):
Security Code (###):
Shipping Information
Shipping Phone Number:
Shipping Address 1:
Shipping Address 2:
Shipping City:
Shipping State:
Shipping Zip Code:
Style Number:
Color:
Quantity:
Price: