Jayne Houston Products

Order Form

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Please provide the following contact information:

            Name 

Shipping Address 

 Address (cont.) 

            City  

           State  Zip Code    Country 

           Phone     E-Mail 

          

Please provide the following payment information:(We accept VISA, MASTERCARD, and DISCOVER)

     Credit Card           Security Code   

     Card Number           Expiration      

      

            

Please provide the following ordering information:

QTY     DESCRIPTION(Item Number,Size)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

Your Order will be shipped by US Mail or UPS (whichever is cheaper)

If you wish a different carrier, please provide the following information:

         Carrier 

          Method