Order Form

The Tie Dye Place Order Form
This simplistic order form is NOT processed via a secure socket layer and does not include calculations.

If you are not comfortable providing personal information online, please print and send to the below mailing address.

PAYMENT OPTION: As a member of Paypal, you may choose to order via this form and then pay via Paypal!

The Tie Dye Place
PO Box 327, 6319 Partridgeville Rd.
Brantingham, NY 13312

Phone 315-348-6349

Please complete the order form:

Item Description/Size	Quantity	Item Totals ($)
1.
2.
3.
4.
5.
6.
7.
8.
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10.
		Order Total
		Sales Tax
		Grand Total Without Shipping

SHIPPING / CREDIT CARD ADDRESS
Name: First	Last
Street address
City
State
Zip code
Country
Phone
email *(REQUIRED)*
Payment Method	Note: you may choose Paypal and then still have the option of using a credit card in Payal.
CREDIT CARD BILLING INFORMATION	PAYMENT OPTION: As a member of Paypal, you may choose to order via this form and then pay via Paypal!
Credit card type
Cardholder full name
Card number
Expiration date

Comments / Notes