FAX In Your Order

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FAX ORDER:
Please PRINT this Page & complete your Credit Card information below. Then, fax your order to: (800) 508-4039 within U.S.

Fax orders not received within 72 hours will be deleted from our system.

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If you need any help with your purchase, please do not hesitate to email us at questions@madamemadeline.com

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Credit Card Payment:	Visa MasterCard AMEX Discover

*Card Number	_________________________________________________
*Expiration Date:	______ / ______ (mm / yy) e.g. 11/16 for November 2016.
*CVV Code :	_____________
*CVV Code :	CVV is the 3 security digit code imprinted on the back of Visa & MasterCard, and the 4 digit code in front of American Express card. (Required!)
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