Gypsy Rose, 1785 Stout Dr. Unit B Warminster, PA 18974
Fax# : 1-215-957-9974 Phone# : 1-800-70-PEACE
WHOLESALE FAX ORDER FORM For your convenience we have provided this fax order form.
For future orders please photocopy.

Date :		Store Name :
First Name :		Last Name :
Address Line 1 :		Address Line 2 :
City :		State/Province :
Zip/Postal Code :		Country :
Phone Number :		Fax Number :

Item#	Qty	Description	Size	Color(s)	Alt. Color(s)	Price	Total
						Grand Total:

Your Notes :