Fantasyland Fax Order Form
Fax:(310) 767-7842
Please be sure to read the Order Information Page BEFORE faxing this form
Name: ________________________________________________________
Home Phone: ________________________________________________________
Daytime Phone: ________________________________________________________  
Fax: ________________________________________________________  
E-Mail: ________________________________________________________  
Street Address: ________________________________________________________  
City: ________________________________________________________  
State: ________________________________________________________
Zip Code: ________________________________________________________
Method of Payment:      Check        Credit Card        Money Order  Check #:________________
Credit Card #: ____________________________ Circle One: Master Card    Visa      AMEX   Discover
Iss. Bank: ____________________________ Expiration Date:____________________
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Residents of California add 9.75% Sales Tax:  
Shipping:  

Total:

  

I do hereby authorize the above charges on my credit card. Sig:______________________________________________________

Prices subject to change without notice.