Contact Name
Company
Organization
Phone
Address
Fax
City
Email
State/Province
Costume Name:
Zip/Postal Code
Description of repairs/cleaning: (Attach additional sheet if necessary) Ship to:
Ship via:
Shipping Acct.# (if applicable)
Date shipped to IMC:
Required date of return:
Payment Method:
Payment for cleaning and repairs can be made by Visa, MasterCard or American Express. For payments by check, please contact Costume Invasion for estimates and pricing.
Payment by: VISA Mastercard American Express Cheque Bill Us
Card #
Expiry
Cardholder Name:
Cardholder Signature:
PRINT OUT THIS COMPLETED FORM AND FAX TO (780) 469-2133 FOR ADDITIONAL INFORMATION PLEASE CALL OUR TOLL FREE NUMBER AT (866) 969-2440
