CONTACT INFORMATION
       
Previous Buyer? If Yes, What Year?
Name Address
Apt # City
State Zip
Day Phone: Evening Phone:
Email    
       
  
SHIPPING ADDRESS
       
Address Apt #
City State
Zip    
       
  
BILLING ADDRESS
       
Address Apt #
City State
Zip    
       
  
USUAL BRA SIZE
       
Number Letter
Center of Bust Actual Rib Measurement
(Under Bust)
Waist Torso
Height Weight
Hips Age:
  
STYLE 1
       
Styles Fabric
Top Size Bottom Size
Qty    
       
  
STYLE 2
       
Styles Fabric
Top Size Bottom Size
Qty    
       
  
STYLE 3
       
Styles Fabric
Top Size Bottom Size
Qty    
       
  
STYLE 4
       
Styles Fabric
Top Size Bottom Size
Qty    
   

Additional Styles / Comments / Custom Requests