Designer Pearl Outlet FAX ORDER FORM Print this form, complete it, and fax to 1-201-568-6590

Item Name Size Color Quantity __________________  __________________  __________________  ____________ __________________  __________________  __________________  ____________ __________________  __________________  __________________  ____________ __________________  __________________  __________________  ____________ __________________  __________________  __________________  ____________ __________________  __________________  __________________  ____________ __________________  __________________  __________________  ____________

SHIP TO Name:_____________________________________ Address 1:__________________________________ Address 2:__________________________________ City / Town:_________________________________ State / Province:______________________________ Zip / Postal Code:______________ Country:____________________________________ BILL TO (exact address as it appears on your billing statement) Name:_____________________________________ Address 1:__________________________________ Address 2:__________________________________ City / Town:_________________________________ State / Province:______________________________ Zip / Postal Code:______________ Country:____________________________________ Daytime telephone number:______________________ E-mail address:______________

SHIPPING METHOD DESIRED (for terms, see our Shipping page)   [__] FedEx Express Saver® 3 day service   [__] FedEx 2Day®   [__] FedEx Standard Overnight®   [__] FedEx Saturday Delivery Priority Overnight®

PAYMENT INFORMATION   Type: [__] Visa     [__] Mastercard     [__] Discover     [__] American Express   CC Number:______________________________________________________   Name on Card (exactly as it appears):___________________________________   Expiration Date (month / year):________________________________________   Cardholder Signature (required):_______________________________________