Darlin’ and Rose Printable Order Form
(Please Print, Complete & Return)

First Name_______________________________

Last Name_______________________________

Address__________________________________

City_____________ State_____________

Zip code_____________________ Province_____________

Email_____________________________________________

Billing addresses for credit card same? Yes __No__

If No: Billing Address ______________________________________

Credit Card #__________-______________-____________

Signature_________________________________________
                        I agree to pay as per credit card disclosure.

Send checks to:

Darlin and Rose
P.O. Box 2594
La Mesa, CA. 91943-2594

Or Fax Your Order To: 619-644-3329

Please allow 2 weeks (or less) for delivery.

Thanks for your order!