"La Boutique Dominique"
Personal Information
Name: _____________________________________ Email Address: ____________________________________
Shipping
Address: _________________________________
City: ___________ State: _________ Zip: _____________
Phone:
___________________
Your
Order
Shipping
and Handling within the continental United
States is included with each order price. For shipping outside of the continental
United States (except where option exists), please include an additional 3.00.
| Item Ordered | Quantity | Unit Price | Total Price |
| Combo Packs | |||
| COMBO #1 Golden Moments DVD & Poster #1 (flat) | $29.99 | = | |
| COMBO #3 Golden Moments DVD & Poster #2 (flat) | $29.99 | = | |
| COMBO #4 Golden Moments DVD & Poster #2 (tube) | $31.99 | = | |
| COMBO #5 Golden Moments DVD & Poster #3 (flat) | $29.99 | = | |
| COMBO #6 Golden Moments DVD & Poster #3 (tube) | $31.99 | = | |
| Photos & Posters | |||
| Photo #1 | $10.00 | = | |
| Photo #2 | $10.00 | = | |
| Photo #3 | $10.00 | = | |
| Photo #4 | $10.00 | = | |
| Poster #1 (Red Leotard) - Folded | $10.00 | = | |
| Poster #2 (Purple Poster) - Folded | $10.00 | = | |
| Poster #2 (Purple Poster) - Tube | $12.00 | = | |
| Exclusives | |||
| Golden Moments DVD (Continental US) | $19.99 | = | |
| Bulk Orders | |||
| BULK ORDER: 10 Photo #1 @ 10.00 each + 5.99 shipping | $105.99 | = | |
| BULK ORDER: 10 Photo #2 @ 10.00 each + 5.99 shipping | $105.99 | = | |
| BULK ORDER: 10 Golden Moment DVDs @ 19.99 each + 5.99 total shipping | $205.89 | = | |
| BULK ORDER: 10 Poster #2 Purple Posters (tube) @ 10.00 each + 5.99 shipping | $105.99 | = | |
| BULK ORDER: 10 Poster #1 @ 10.00 each + 5.99 shipping | $105.99 | = | |
Shipping
is free within the continental United States. Please add 3.00 for shipping to Hawaii, Canada or outside of the U.S. |
SHIPPING | = | |
| >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> | >>>>>>>> | ||
| TOTAL | = | ||
|
If you would like your item personally autographed as a complimentary service, please print the name to which you'd like each item autographed: Name:
____________________________Item #1:____________________________
|
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| SEE BELOW FOR INFORMATION ON SHIPPING AND HANDLING! |
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Shipping and Handling within the continental United States is included with each order price. For shipping to Hawaii, Canada or outside of the continental United States, please include an additional 3.00.
Mailing
in your Order
We welcome any and all orders via postal mail. Email
orders will only be accepted via PayPal using the e-mail address boutique@dominique-moceanu.com.
Payment forms accepted include: check, money order, cashiers
check (US Currency Only).
MAKE ALL CHECKS PAYABLE TO: "DOMINIQUE MOCEANU"
Please
mail your completed order form, along with payment to
"La Boutique Dominique"
c/o Dominique Moceanu
Gymnastics World
6630 Harris Rd.
Broadview Heights, Ohio 44147
Please allow 4-6 weeks for delivery.