Order Form

Martina Burano Home Collection ORDER FORM

Print out this form and Fax to +39 041 735581
Or mail your order at: Mail to order@martina-lace.com

STEP ONE: Ordered By:

Name	_________________________________________________________________
Address	_________________________________________________________________
	_________________________________________________________________
City/State/Zip	_________________________________________________________________
Tel	_________________________
Fax	_________________________
e-mail	_________________________

STEP TWO: Payment Method

Credit Card Account	________________________________________
Expiration date	________________________________________
Name on card	________________________________________
Signature as shown on credit card	________________________________________

STEP THREE: Order Here

Code Description Quantity Price TOTAL

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TOTAL €                           -

Please know that the total due does not include shipping costs nor import duties. Once we have received your order form, we will inform you about the exact shipping charge to be paid. Thank you for your order.