Order Form
(Printable Version)



If you do not wish to use our electronic Order Form we will accept orders using this form and payment by check or money order.  (If you wish to use a credit card you may do so ONLY through PayPal, a secure third party method of paying us with your plastic. For more information about PayPal click here.)     Mail this completed form with your payment (allow 10 days extra for check payments) to:

Coup de Foudre LLC
P.O. Box 9
Annapolis, MD. USA 21404-0009

Telephone 410/ 961.6302
Fax 507/ 262.3073















Name
Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Please provide the following information about your order

Catalog / Item#

     Description / Name

   Price

SUBTOTAL    

   

SALES TAX (in Maryland add 5%)

SHIPPING & INSURANCE (circa 5% of subtotal)

TOTAL   

 




BILLING - Charges will be processed through PayPal.

Credit Card

Cardholder Name
Card Number
Expiration Date

ZIP Code

(of card billing address)
Email address (required)

 

SHIPPING (if different from above)
Name
Company
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
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