For FAX Orders, please complete all of the information below, and print this form. Orders faxed to 920-886-1686
Please complete your order below:
  Number Product Name Size/Color Quantity Price Item Total
1. $ $
2. $ $
3. $ $
4. $ $
5. $ $
Items Total $
Shipping & Handling
$50.00 & Less $10.00
$50.01 - $75.00 $11.00
$75.01 - $100.00 $12.00
$100.01 - $125.00 $13.00
$125.01 - $150.00 $14.00
$150.01 - $250.00 $15.00
$250.01 - $300.00 $16.00
$300.01 - $400.00 $17.00
$400.01 & Up FREE
Canada, Puerto Rico add $10.00
Overseas Sorry, Not accepting overseas orders at this time.
2 days Exp in U.S. add $13.00
1 Day Exp in U.S. add $19.00
Please calculate the shipping cost from the above chart Shipping Cost $
Final Total Items Total + Shipping Cost $
Please enter your shipping information:
First Name : Last Name :
Company :
Shipping Address :
City : State : Zip :
Please enter your billing information:
First Name : Last Name :
Company :
Phone Number: :
Billing Address :
City : State : Zip :
If paying by Credit Card, please enter your credit card information:
Credit Card Type:
Card Number :
Expiration Date :
Month /
Year
CVV2 number : Click here for CVV2 details
If paying by other method, please select method below:
Cashiers Check      Money Order
If paying by Cashiers Check or Money Order, your order will be shipped when payment is received.

Please fill out, and fax this form to 920-886-1686
If you are joining us by mail please be sure to send us the completed, printed form. If you are paying us by cashiers check or money order please send us the completed, printed form along with your cashiers check or money order. Make cashiers checks or money orders payable to:
Simply Sexz Exotic Apparel

If paying or ordering by mail:
Simply Sexz Exotic Apparel
1466 County Rd O
Neenah, WI 54956