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ORDERED BY

Name ___________________________________

Address _________________________________

City, St Zip ______________________________		 PAYMENT

(    )  Check
(    )  Money Order
(    )  Visa
(    )  MasterCard
(    )  American Express 

SHIP TO   (if not the same as Ordered By)

Name ___________________________________

Address _________________________________

City, St Zip ______________________________		 CREDIT CARD
__ __ __ __    __ __ __ __    __ __ __ __    __ __ __ __ _____________  
Account #                                                                               Exp. Date
____________________________________________   _____________
 Signature--Name as it appears on Credit Card.                Security Code
PHONES & E-MAIL

(day) _____________________________ 

(evening) ___________________________

(e-mail) _____________________________

NOTE 
Our company does not share customer phone numbers or credit
card information. Occasionally we trade addresses with other
like-minded, socially responsible companies.
 
(     )  Check here if you prefer NOT to receive other mailings.

  Item #      

   Preferred Color

  Alternate Color

  Size  

Qty

Price

 TOTAL 
            $
             
             
             
             
             

$5.95 Delivery & Handling is First Class Mail for U.S. Shipments.  
For Priority Processing within the U.S., the $5.95 D&H will be
charged plus the Priority Mail charge.
Priority Processing & Shipment is $4.95;  Express Mail is $29. 
D&H on packages mailed to countries other than the U.S. is $5.95
plus 25% of the order for Air Mail, 35% for Global Priority Mail.  
NOTE:  For bulk orders, we need to charge an additional amount to
cover our increased postage cost.  The amounts are specified below.
               $200-$499  $8;     $500-$999  $12;     Over $1,000  $15

 SUBTOTAL  
DELIVERY & HANDLING--see note
to the left regarding bulk orders

 $5.95
PRIORITY PROCESSING--$4.95  
NC Add 6.75% Tax--(include D&H)
Mecklenburg County 7%		  

THANKS FOR YOUR ORDER!

ORDER TOTAL

  

We want you to be satisfied with your purchase.  If an item does not fit or is not satisfactory,
simply return it to us in unused condition within 30 days.  We'll exchange it or refund your money.  

PLEASE NOTE:  Delivery charges are not refundable. Underpants and special orders can not be returned.
www.cottonbras.com
Back to Basics Soft-Wear, Inc. 10508 S. Lowell Rd. Bahama, NC  27503-8779    Phone (919) 477-5669;   Fax (919) 321-2044