Home Phone:
Work Phone:
Cell Phone:
Email:
Prefered Method of Contact:
Would you like to receive our Newsletter? Y/N
Corset Style:
Size:
Material:
Contrast on Binding?:
Grommet Color: (Nickel, Black, Brass, Antique Brass[Add’l $5])
Add-ons:
Garters: ($10 per pair) (None,2,3,4):
Width: (3/4” or 1/2”)
Back Panel: (Y/N)
($25-Fabric, $30-Leather, $35-Patent)
Credit Card #:
Card Type (Visa/Master/AMEX):
Expiration:
Name on Card:
Billing Address:
Billing Contact #:
*****Please note*****
Submission of this form is only the first step in
the process of creating a corset. A deposit
of 30%-50% of the total cost must be made up
front. Client will be contacted before the
charge is placed.