Clothing Catalog Order Web Form

Clothing Catalog Order Form

A J Wards Catalog Inc. 98877 N 2nd St. Suite 2 Chicago, IL 55501

Enter Your Catolog Product Selections Below
Item # Item Description Size Color	Price	Qty	Total





Sub-Total:
Shipping & Handling (7.00%):
Grand Total:
Please enter all required information. The prompt processing of you order depends on it.

Customer E-Mail
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Billing Information
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First Name Last Name
Address
Street Address
Address Line 2
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ZIP / Postal Code Country
Shipping Information
Same as billing information? Yes No
Name
First Name Last Name
Address
Street Address
Address Line 2
City State / Province / Region
ZIP / Postal Code Country
Payment Information
Credit Card
Card Number Card Brand
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