Order Form

Bags Bandanas Belts Body Jewelry Bracelets Brooches Buckles Caps and Hats Car Accessories Earrings General Merchandise Hair Accessories Jeanchains Keychains Necklaces Neckties Rings Scarves Sunglasses Suspenders Wallets Webbings Wigs

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

Company Name:

First Name:

Middle Name:

Last Name:

Shipping Phone Number:

Shipping Address 1:

Shipping Address 2:

Shipping City:

Shipping State:

Shipping Zip Code:

Style Number:

Color:

Quantity:

Price: