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MADAME'S PORT - ORDER FORM
Please use this form only if you are going to mail or fax your order to us.

If you want to place an order by phone, or if you have any questions on an item or order - please call 609.884.5858

Return Policy for Furniture:
20% restocking fee for returned or canceled orders

MAIL ORDERS TO:
Madame's Port
311 Washington St.
Cape May, NJ 08204		 FAX ORDERS TO:
Madame's Port
1.609.898.8511 
  Item # Description Quantity Price Each Sub Total
1.          
2.          
3.          
Sub Total:  
 (NJ Only) 6% Sales Tax:  
Discount or Promotional Code:  
Total:  
 

Credit Cards Billing Information (US Orders Only)
Name on Credit Card  

Visa         MasterCard
Billing Street
Credit Card Number
Billing City, State, & Zip Code
Expiration Date
Billing Phone Number
Security number on back of Credit Card
Signature:

Contact Information
Phone Number
day        evening
Email Address
We value your privacy, and the contact information that you provide will only be used for this order.

Shipping Information

Check Here if Same As Billing Address
Ship To Name:
Shipping Street Address
Phone Number:
City, State, & Zip:
   
: