Black Tie by Lori Measurement & Ordering Form

Date of Use:*
Date Format: MM slash DD slash YYYY
Bride's Name*
First Last
Groom's Name*
First Last
YOUR FULL NAME*
First Last
Your Address:*
Billing address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best Contact Number:*
Your Email:*
Enter Email Confirm Email
Coat Size:*
Height:*
Weight:*
Chest Size (in):*
Chest over-arm (in):*
Waist (in):*
Hip (in):*
Out Seam (in):*
Shirt Neck:*
Shirt Sleeve:*
Shoe Size/Width:*
My normal pant waist size:*
My normal INSEAM:*
Comments
Terms & Conditions*
There is a required $50 non-refundable deposit for all new rental orders. No REFUNDS, EXCHANGES, OR CREDITS are available on rental or retail merchandise. Rental items should be picked up on the Pickup Date and tried on in our store to insure the proper fit. BlLACK TIE by lori does not accept responsibility for the fit of merchandise where the customer was not measured by one of our employees, however we will attempt to resolve all issues quickly. Rental items not returned the day after the event will be charged a late fee of $25 per day. If there are any missing or damaged items, the customer will automatically be billed for the replacement item. We accept Visa, MasterCard, Discover, or Cash on the day of pickup. NO CHECKS. Ask about our rent to own program! BLACK TIE BY LORI appreciates your business! I agree to pay the above total amount according to card issuer agreement. No refunds or exchanges
- I accept these Terms of Sale/Purchase
Minimum Payment:*
Price: $50.00
To make a larger payment -- Adjust price here*
Select Form of Payment*
- Credit Card
- I will call store with payment
Credit Card*

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MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
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