Luv My Pooch - Mail Order Form

	Please complete the form below, print it and include it with your order. If paying by check or money order, complete shipping information and contact information.

Billing Information
Name:
Address 1:
Address 2:
City:
State:
ZIP Code:	(5 or 9 digits)

Credit Card Information
Credit Card:
Credit Card Number:
Expiration Date:
Security Code:	(Last three digit code on the back of the Visa, Mastercard or Discover card. The four digit code above the last #'s on the front of American Express card.)
Signature:

Shipping Information
Is Shipping information the same as your credit card billing? Yes No (Enter shipping information below)

Name:
Address 1:
Address 2:
City:
State:
ZIP Code:	(5 or 9 digits)


Contact Information
Email Address:
Telephone Number:

Privacy Policy:	Luv My Pooch will never sell or rent any of your personally identifiable information to third parties.


Shipping & Handling Charges (Per order):

$0.01	to	$9.99	add	$3.95
$10.00	to	$49.99	add	$5.95
$50.00	to	$99.99	add	$7.95
$100.00	to	$199.99	add	$9.95
$200.00		and up	add	$11.95

Total the order, add appropriate shipping & handling charge from the table above and add appropriate sales tax for shipments within New York State.

On the back of this page, please include the item names, brief description, option for each item (color, style, etc.), quantity desired and price. Use additional pages as required.

Mail to: Luv My Pooch, 163 Amsterdam Avenue #219, New York, NY 10023 or

Fax to: 212-595-1716

Please tell us how you heard about
Luv My Pooch: