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Payment Form

     Once we have looked at your order and discussed all the details, use this form to pay us. The form will generate a print-out. Fax the letter of authorization to us in order to confirm your order. Alternatively, you can mail the form to us. For security reasons please do not send by e-mail.

Authorization Form: Yes, I would like to confirm my order from Adam & Eve Fashion House.

Please Note All Fields Must Be Entered
Passport No.:
Date of Birth: (date/month/year)
I, hereby authorize Adam & Eve Fashion House to
Deduct the sum of: U.S. Dollars
From my Credit Card:
Card Number:
3 or 4 Digit Code: Click Here
Expiry Date: / (MM/YY)
Please specify the kind of fabrics, colors, & designs you are interested in:
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