Orderform suspenderbelt and gaines

Please fill out all required fields

Mr/Mrs

Family name

E-mail

To order a suspender belt

By ordering we need: model number, colour, and your natural waist size.
Desired model number

Colour

Desired waist size
	Second selection
Desired model number

Colour

Desired waist size

To order a gaine

By ordering a gaine we need: model number, colour, and your natural waist size.
Desired model number

Colour

Desired waist size
	Second selection
Desired model number

Colour

Desired waist size

Payment information

Please add the following P and P costs to the grand-total. Netherlands Eur 7,95, Europe Eur 13,- , outside Europe Eur 23,-.
Shipment information


Name

Address

ZIP

City

Country

Payment information


	by transfer to our bank account 10.65.65.672
	payable to J.C. Creations. IBAN: NL56 RABO 0106 5656 72 BIC: RABONL2U
	by transfer to our postbank account 73.69.380
	payable to J.C. Creations. IBAN: NL34 PSTB 0007 3693 80. BIC: PSTBNL21
	Creditcard
	We accept VISA and Mastercard
Creditcard information


VISA or Mastercard

Name as mentioned on the card

Number

CVC Code

Expiry date

You can order by clicking on the button below "Send". Or print the form and send it by fax or by post.

J.C. Creations, p.o. Box 2195, 1000 CD Amsterdam. The Netherlands. Our faxnumber 0031-(0)20-4197222.