Fluff-Aid Donation Form

If paying by VISA or MasterCard, print this form, fill out & fax to Jill at 301-762-6422. If no fax available, charge orders may be phoned in to 301-762-6022 between 11 AM-9 PM Eastern. If paying by check, print & complete this form and mail with payment. Make checks payable to MD BICHON FRISE RESCUE, INC. and mail to Jill Siegel, 13400 Valley Dr., Rockville, MD 20850. Orders paid by check will process after check clears.

If you want your item shipped to an address other than the one at top of form, put the BILLING ADDRESS
in the top portion, and the SHIP TO address at the bottom under Special Instructions. Thank you!

Name on Check
or Credit Card
Address
City, State, ZIP
Daytime Phone
Email Address
Form of Payment: VISA ____ MasterCard ____ Check/Money Order____
Credit Card #
Please don't use a BUSINESS CREDIT CARD (fees are DOUBLE for them)
Expiration Date (mm/yyyy)
CVV2/CVC2/CID
3-digit # on back of card

ORDER - If need more space, write additional items below chart or under Special Instructions

Quant.
Fluff-Aid #
Item Description
(if selected, specify choice of collar cover, candle scent or matted print) 		Donation
Amount
Shipping*
 Total
Donation
      $ $  $
      $  $  $
      $  $  $

*Shipments to Alaska, Hawaii and outside of the US will incur shipping charges. For all others, items will be sent via USPS first class, USPS Priority or FedEx Home Delivery/Ground shipping based on size. weight and destination of items being shipped. You may pay additional amount to cover expedited shipping costs. Items are all in stock. If you are hoping for delivery before 12/25, items will be shipped as quickly as possible once order and payment are received.

Special Instructions

 

 

 

 


Thank you very much for your order!
* 100% of the profits go to Bichon Rescue to help bichons in crisis *