The Basement Gifts 5025 Lemay Ferry Rd St. Louis, MO 63129 (314) 487-3980 FAX: (314) 296-4303

Fax Order Form

Billing Address:		Shipping Address:
Name:		Name:
Address:		Address:
Apt#, Suite:		Apt#, Suite:
City:		City:
State, Zip:		State, Zip:
Phone#:		Phone#:

Item#:	Item Name:	Color:	Quantity:	Price:	Total:

Payment Information:	Merchandise Total:
Circle:   Visa   MC   Discover/Novus   AMEX   Check	Sales Tax (MO only)
Credit Card No:	Oversize surcharge:
Expiration Date (Mo/Yr) ___ / ___	Shipping (see Shipping Costs)
Signature:	Grand Total:

Please fax this completed form to: 417-877-9922

OR

Mail it with your check to: tights-n-things 2676 S. Glenstone Avenue Springfield, MO 65804