CottonJunction Order Form
(We request that you send fax order without a cover page.)
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Credit Card Holder (Payee)
Street Address
    
City
 State
 Zip Code
 
Phone Number or Email Address
Ship to Name
Ship to Address (if different)
    
City
 State
 Zip Code
 
Phone Number or Email Address
  Style Size Quantity Color Cost
1. Rugby (CJV-100)
2. Rugby (CJH-100)
3. Rugby (CJS-100)
4. Pique (CJ-130)
5. Pique (CJ-130)
     
  Totals: Rugby
 + Polo
 - Valued Customer Discount
Click here to calculate total		 = Total
     
(Note: If you are entitled to a Valued Customer Discount, please enter the amount in the above box.
See "About CottonJunction" for details.)
     
    Type
 Credit Card Number
 Exp. Date
  
    
I authorize the amount in "Total" to be charged to my credit card.

Signature __________________________________________________________

Complete and fax this form to Cottonjunction @ 1(888)436-7616.
100% satisfaction guaranteed.

Your order will be processed and shipped within 48 hours via UPS, US Mail, or other equivalent. Transit time in continental US approximately 1 to 3 working days.