Printable Order Form
To submit an order, please print this form and mail to:
Dicks Online Orders
117 Space Park Drive
Nashville,TN 37211
Please make out checks to Plan It Promotions
Or Fax to:
615-832-9949
Please allow 1 to 2 weeks for shipping.
Items Ordered:
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Item Number
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Item Title
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Size
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Color
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Quantity
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Price
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e.g. 00125
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e.g. Short-sleeve T-shirt
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e.g. Med
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e.g. Blue
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e.g. 1
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e.g. 14.95
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Plus 9.25% sales tax (TN residents only)
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Please call 615-832-9944 for Shipping & Handling Price
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Total
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For more items, please print and include a second form.
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Customer Information
*First Name ________________________
*Last Name ________________________
Company ________________________
*Email ________________________
Phone _________________________
Credit Card Information
*Card Type ________________________
*Cardholder’s Name As Shown On Card ___________________________________
*Card Number ______________________
*Expiration Date (mmyy) ____ / ____
*3 Digit Security Code _______________
*Required fields.
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Billing Address
*Address Line 1 ______________________
*City _______________________________
*State/Province _______________________
*Country _____________________________
*Zip/Postal Code ______________________
Shipping Address (if different from billing address)
Ship To Name __________________________
Address Line 1 __________________________
City __________________________________
State/Province __________________________
Country _______________________________
Zip/Postal Code _________________________
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Thank you for ordering from Dicks Last Resort online. If you have any questions, please do not hesitate to contact us by phone at: 615-832-9944 or by email at: piprom@comcast.net
