Marie's Order Form

Please complete the following form to place your order. We will calculate the form and confirm your order by email.

Rocawear Suits ($59.99): Size: Color:

Roc Tops ($39.99): Quantity: Color:

Rocawear Jewerly ($79.99): Quantity: Color:

Roc Shoes ($80.99 or more): Quantity: Color:

Children Section
Roc Shoes ($20.99 or more): Quantity: Color:

Roc shirts ($13.99 or more): Quantity: Color:

Roc jeans ($15.99 or more): Quantity: Color:

Roc Jewelry ($25.99 or more): Quantity: Color:

Shipping and Handling:
$50.00 orless~$12.59
$100.00 or more~$20.59
$300.00 or more~$30.59

If you would like to have a catalog please purchase:

One Month Subscription
$19.95
Three Month Subscription
$35.95
Six Month Subscription
$49.95
One Year Subscription
$59.95

General Information
(As Shown On Your Credit Card Statement. Your Address Will Be Verified.)
First Name: Last Name:
Address:
City: State: Zip:
Country:
Phone Number:
E-Mail Address:
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Credit Card Information
Card Number: Exp. Date:

If you would like, you may specify an alternate shipping address. Enter that information here.
First Name: Last Name:
Address:
City: State: Zip:
Country:

Submit this form ONCE ONLY.
Your credit card information will be processed in real-time. You should receive a response in about 15-25 seconds. However, if Internet traffic is unusually high, the tranaction could take longer than usual. Pressing the submit button multiple times will cause multiple charges to your credit card account.

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