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Avon Order Form Example
Avon Online Order Form Example
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Avon Online Order Form
Linda Ortega
Independent Sales Rep
505-173-1545
linda_ortega_avon@yahoo.com
www.youravon.com/lortegaavon
Enter Your Catolog Product Selections Below
Prod#/Description
Price
Qty
Total
Sub-Total:
Tax (IL 8.45%):
Shipping & Handling (7.00%):
Grand Total:
Customer E-Mail
E-Mail:*
Billing Information
First Name:*
Middle Initial:
Last Name:
*
Address Line 1:*
Address Line 2:
Phone:
City:*
State:
*
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
*
Shipping Information
Same as billing information?
Yes
No
First Name:*
Middle Initial:
Last Name:*
Address Line 1:*
Address Line 2:
Phone:
City:*
State:*
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:*
Payment Information
Payment Method:*
Credit Card
Other
Card Number:
*
Expiration Month:*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Year:*
Year
2009
2010
2011
2012
2013
2014
2015
2016
Card Brand:
*
Choose a Card
American Express
Discover
Master Card
Visa
Reset
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