Private Affairs
Lingerie Club
Home of the Finest in Lingerie
Order on Line

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Name:

Member #:

Address:

City:

State:

Zip Code:

Telephone:

E-Mail:

Please Select the catalog you are ordering from

1 st item
item # from catalog & Size:
&

2 nd item
item # from catalog & Size:
&

3 rd item
item # from catalog & Size:
&

4 th item
item # from catalog & Size:
&

5th item
item # from catalog & Size:
&

if you would like to order more then 5 items please list them in the notes
(eg. 1234**m or 1234**36c )please put a few spaces between each item.
Note:

Credit Card
Credit Card #

Expiration Date:

Is the address and zip code the same as the mailing address above. if not please input here
Address (numbers only)Zip code

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