Brilliant Dreams for Vivid Dreams

FAX ORDER FORM

Please follow the instructions below then fax this page and your order invoice/confirmation page to: 1-866-691-7902

Fax Order Instructions:
  1. Visit the Order Page
  2. Place your order online and choose FAX as your payment method. Make sure you enter your correct Bill-To address (and Ship-To address if different) and indicate the preferred/appropriate shipping method.
  3. Print your order confirmation page.
  4. Fill out the payment form below, sign it, and fax both the order confirmation page and this completed payment form to: 1-866-691-7902

Order Details:

Order ID (found on order page):
First Name:
Last Name:
Email:
Phone:

Payment Information :

Order Total in US Dollars:

$

Credit Card Type:

Credit Card Number:

Exp. Date (MM/YY):

Credit Card Code:

The credit card code (CVV2 code) is a three-digit number that is printed on the back of Visa, MasterCard and Discover cards or a four-digit number on the front of American Express cards. The number appears in reverse italic at the top of the signature panel at the end of the card number on Visa, MasterCard and Discover Cards or on the front, just to the right or left of the card number on American Express cards.
Click here for examples.


Signature: ___________________________________

Comments: __________________________________________________________________ 

Alternatively, you may mail your order confirmation and this completed payment page to:

Brilliant Brands LLC
1031 State St. NW, Ste. 101
Atlanta, GA 30318 USA

Your order should ship within 24 hours of your credit card being charged.