The following information is Required for order processing.
    Name:
    Address:
    City:
    State:
    Zip/Postal Code:
    Telephone:
    Email Address:

    We accept VISA, MasterCard and American Express.

    Cardholder Name:

    Credit Card Number:

    Expiration Date:

    Order Buckle(s):
    Product #1: Quantity:
    Product #2: Quantity:
    Product #3: Quantity:

    Order Belt(s):
    Crocodile/Alligator: Quantity:
    Crocodile Embossed Calfskin: Quantity:


    Order Vanity Jar(s):
    Product #1: Quantity:
    Product #2: Quantity:
    Product #3: Quantity:

    Order Cuff Link(s):
    Product #1: Quantity:
    Product #2: Quantity:
    Product #3: Quantity:

    Gift Wrap Pouch:Add $1.50
    Rush Delivery:Add $18.00

    For special orders, please contact us at 203-853-3264.



    Shipping and handling will be billed at 3% of total invoice charges per each address.
    Orders are shipped, with only a few exceptions, within two or three weeks of their receipt.
    Whenever possible, we ship via UPS in the continental U.S.A. and Alaska. Please allow
    additional time for international delivery. For foreign countries, the handling charge is
    $15.50 plus the actual shipping expense. Taxes and applicable duties paid by recipient.
    If you choose to fax this form, please fill out all fields
    on your computer, then it may be printed and faxed to:
    (203) 838-3638 anytime, seven days a week. Thank you!

    Once your order has been processed, you will receive an
    email confirmation and then we will begin to process your
    credit card or payment information. It is important to include
    your email address on this form.

    We accept Visa, Master Card and American Express via Fax or Phone.
    We also accept Bank Checks, Money Orders and Personal Checks
    (which take seven (7) business days to clear)
    .....................

    © Lyn Gaylord Belts & Accessories 1999-2002