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DesignHERS Printable Order Form
The following page can be printed and either faxed or mailed to DesignHERS, with your order.
PO Box 316, Woodbury, NY 11797. (516) 933-1069 Fax 1-866-336-1544
1-888-237-9350 Toll Free Order Line
Name:
E-mail:
Address:
 Apt #:
City:
State: Zip:
Country
Phone #:
Qty
Item #
Description
Color
Size
TOTAL PRICE

Shipping & Handling

$5.95 For orders under $50
$6.95 For orders $50 - $100
Free For orders over $100

International Order $20.00 1st Item
And $2.00 Each Additional Item
Item Total
Postage & Handling
Sub-Total
New York State Residents add 8.75% sales tax

TOTAL AMOUNT DUE
Payment Type: Visa MasterCard Check Money Order
American Express Discover
Credit Card No.:
Exp. Date:


Signature:

 ____________________________
Authorization: In order to process your order, we need to have verification that you are 18 years of age or older and believe that none of the material that you purchased is pornographic. You also believe that all purchases are within the standards of your area and will not be redistributed to minors and all products are sold for novelty use only.
I agree to the above statement Signature:____________________________