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Customer Information
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Name:
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E-mail:
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Event Date:
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Cell Phone:
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Alt Phone:
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Delivery/ Pickup Information
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I would like to pickup my order
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I would like my order delivered (if available)
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Delivery Date:
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Special Instructions:
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Delivery Address/ Information:
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Order Information/Electronic Signature
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I would like to order the items on my Estimate #
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I already paid my depsit and have an Invoice #
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Online Order Terms and Conditions:
Orders placed online are subject to a 50% cancellation fee, even if the credit card payment has not been processed.
Customer agrees to the Rental Terms and Conditions
(Please click on the link and read before proceeding) Print the Terms and Conditions for your records.
Orders submitted online are not guaranteed until you receive a confirmation invoice, as we must check availability. Our online order
system is not for last minute orders. This system is for events at least 2 weeks to 30 days away. Final Selections/ Counts and
Cancellations must be received no later than the Friday, two weeks prior to the event. ALL PAYMENTS ARE NON REFUNDABLE.
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Electronic Signature:
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Initials:
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I agree to these terms and agree to pay a 50% cancellation fee if I decide not
to proceed with this order for any reason.
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Payment Information- Mandatory Credit Card Info
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This system does NOT charge your credit card , it is strictly for informational purposes only. Charges
are run manually in our store. If you have already paid in full, you will NOT be charged twice. A valid
credit card must be kept on file, even if you are paying by check or cash.
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Name on Card
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Address:
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City:
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State:
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Zip :
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Please enter the last four digits of your credit
card number, then call our office with your
complete number.
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Last Four Digits:
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Expiration Date:
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(Back of MC, Visa, and Disc)
or 4 Digit Code on the front of Amex
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3 Digit Code:
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I have already paid the deposit over the phone or in the store
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I have already paid in full
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I would like to pay in full today
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I would like to pay a 50% deposit, and will call with my credit card number
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Please charge future payments to this card
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My order totals over $1500 and I would like pay a 25%
deposit, and I agree to a monthly payment plan, with
automatic payments each month until my event.
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Submit your Confirmation
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By clicking the "Submit" Button, you are confirming your order and authorizing
Simply Elegant to charge your credit card for damages or missing items, and/or
rental fees
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ALL PAYMENTS NON REFUNDABLE
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