s! I would like to proceed with my order from LACKMAN Custom Tailor.

Name  (as it appears on your card)
Street Address 1
Street Address 2
City
State or Country
Zone or Zip Code
Telephone
Order Number
(We will send this to you when confirming your fax)

I hereby authorize BlackMan Custom Tailor to deduct the sum of U.S. $   from my credit card below:  

AMERICAN EXPRESS  
MASTER CARD  
VISA  
DINERS CLUB  
Card No. 
Expiration Date
For AmEx Card only - Enter the four digit number appearing on the right hand corner of your card.  

Signature as it appears on your card ................................................

We accept the following credit cards

Instructions:

  1. Complete all of the information above. Incomplete or incorrect information will delay your order.
  2. Print this form out from your browser.
    Under the FILE pulldown menu, select PRINT FRAME
  3. You may either mail this form to us or fax it to us at 82-351-868-8500.
  4. Do not email the form to us for the security of your credit card information.

PLEASE FAX OR MAIL THIS FORM TO:
 

Blackman Custom Tailor
#570, Saengyun-Dong
Tong Du Cheon City
Kyong Ki Do, Korea
Zip 483-034

82-351-868-8500 (Fax)

PAYMENT CAN ALSO BE MADE BY BANK/POSTAL CHECK OR MONEY ORDER, PAYABLE TO "BlackMan Custom Tailor"