Instructions:
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Fill out the form and then send OR FAX it to the address at the bottom.
MAIL ORDER FORM & LETTER OF AUTHORIZATION
I would like to place an order with the Phuket Boss Tailor Group for the following Items:
____________________________________________________________________
____________________________________________________________________
Here are my Details:
Name:
_________________________________________________
Address: _______________________________________________
_______________________________________________________
_______________________________________________________
Country: __________________ Passport
No. _________________
Tel: ______________________ Fax: ________________________
I hereby authorize Phuket Boss Tailor to deduct the sum of:
US $: __________________ from
my credit card as per details below:
American Express
Master Card
Visa
Euro Card
Diners
Card
No : __________________________
Valid until (date): ___________________
Signature as on card: __________________________
Please fax or mail this form to:
PHUKET
BOSS TAILOR
UNIT 3-4, CANAL
VILLAGE, LAGUNA PHUKET,
THALANG, PHUKET 83110, THAILAND
email: bosstail@loxinfo.co.th
Tel: 66-76-324511, 66-76-244616
Fax: 66-76-244590 
PLEASE AIRMAIL THIS FORM TOGETHER WITH
A PHOTOCOPY OF YOUR PASSPORT AND CREDIT CARD. YOUR INFORMATION WILL BE
KEPT STRICTLY CONFIDENTIAL.