Off-Line Order Form

Fill the form below (type or write by hand), print and fax or mail to:

Assunta Anichini s.a.s., via di Parione 59/r

50123 FIRENZE, ITALY

Fax (0039) 06-233-16050
E-mail anichini@anichini.net

1.MAILING INFORMATION
 Name
 Address
 City State
 Zip/Postal code Country
 Phone Fax (optional)
 E-mail (optional if you want an e-mail confirm of your order )
  Yes, when you receive my order, please give an e-mail confirm.

2.SHIPPING INFORMATION
 Only complete this area if you would like the order to be shipped to an address other than the one listed above (i.e. a gift)
 Name
 Address
 City State
 Zip/Postal code Country
 We will enclose a gift card if you like, just tell us what you want to say:
 
 

3.CREDIT CARD INFORMATION
 Select your credit card type:
VISA MASTER CARD AMERICAN EXPRESS
 Name as it appears on card
 Credit Card Number Expiration Date (mm/yy)
 Security Number Date of birth (dd/mm/yyyy)
ATTENTION! After printing don't forget to sign for acceptance

 

Signature.................................................................................................................

4.SHOPPING BASKET
 Article name  Fabric  Color Sleeves:
S (short)- L (long)
SS (sleeveless)		 Size  Price 
 
   
   
   
         
         
SHIPPING RATE:
DHL International Carrier.

Select your country
referring code
optional (only if given)---------
 GRAND TOTAL   
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