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Scrubs by ZZTopps
Whimsical & Seasonal Scrubs
Uniform Scrub Shirts, Jackets & Pants
Made Just For You

Order Form
This is a manually created form - you must fill out all information - it cannot calculate costs and shipping for you.
(For Fax, Email or Snail Mail - Instructions at bottom of form)

Name: Date:
Address:
City: State: Zip Code:
Phone: E-mail:

 

 

 

Size

Garment Style
(If ordering pants please list inseam measurement here also.)

Fabric Choice

# Pockets

Scrunchie or Headband

Cost
           
           
           
           
           

Sub-Total

  

Shipping ($0 - $50.99 20% of order total
$51 or more 10% or order total
Free Shipping within 40 mile radius of Warren, IN)

  

Total Order Cost

  


Payment to be made by (Check One):  _____Money Order _____Cashier's Check
                                                                             

FAX to (260) 375-7007 
or
Select All (Ctrl A), Copy (Ctrl C), and Paste (Ctrl V) 
this page into your email program, complete and send to
Nicki@ZZTopps.net

If ordering by "snail mail", please email Nicki@ZZTopps.net
your fabric choice so that I can reserve it for you.

Snail Mail Address

ZZTopps
PO Box 695
Warren, IN  46792