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SPECIAL ORDER FORM
Eesh Formals
15440Ridge Park Dr.
Houston, TX 77095
Name of the Person for whom ordering: ____________________
Wear Date: (mmddyy) _ _ _ _ _ _
Style # Color: Size: _
_ #of items_ _ Price (if known)
NAME
of the person placing the order
(as on the card)
(First)
(Middle)
(Last)
ADDRESS:
(Street)
(Aptt.#)
(City)
(State)
(Zip)
PHONE:
(Home)
(Office)
(Cell)
E-mail
address:
CREDIT CARD : MC / VISA __ ; AMX __; DISCOVER __ ; Debit __
CREDIT CARD #:
EXPIRY DATE:_ _ _
_ _ _
 Give us your card ID #( it is always in the front of AMX card as shown and at the back of M/C and Visa - the last 3 digits)
mm dd yy
Special notes:(if any):
Please arrange the above said dress(es) and mail to the following
address:
___________
_________________
_________________
The above said card belongs to me and I, in my full senses, authorise / give my consent to Eesh Formals (15440 Ridge
Park Dr., Houston, TX 77095) to charge my credit / debit card for the price of the dress + tax (if any) + mailing charges.
I understand that Eesh Formals has the right to cancel the order if the items could not be arranged and shipped in
time. In that case, if my card has been charged I will be given refund for the same. I further understand that
once the order has been placed with the manufacturer, it can not be cancelled and no refunds or exchanges are allowed.
I, further, understand that the items once shipped to me by Eesh Formals, will, in no case, be returnable or
exchangeable. I understand that no refunds will be given for the said item once sold to me.
_______________
(Signatures of the Card owner)
___________
(Date signed)
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