Wedding/Group Name :
Event Date : (MM/DD/YYYY)
Type of Event:
Store Pick-Up Location :

First Name :
Last Name :
Address :
Apartment #:
City :
State : Zip :
Phone :
Email :
Re-enter E-Mail:
Phone Other :
Preferred Method of Payment : Cash Check Credit/Debit Card
Select Card Type : VISA Master Card Discover

Credit Card # : _____________________ Exp : _________

Print, hand write your credit card # and then FAX this form to us. Fax#: (570)347-5246
Height :
Weight lbs. :
Age :

Note: required for proper fit for children
Tuxedo Jacket :
Trouser :   or Note : we prefer outseam                                                                                                                     measurement
Shirt :  

Shoes :   Note: Wide width only available on
                                                                       mens shoes size 7+

Comments/Special Instructions:

 
 
 
  Gifts
 
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