MD: 410-433-4999
DC: 202-737-7144
FAX: 410-433-5965
EMAIL: info@valetformalwear.com

Name: _______________________________________________ Date: _________________
Location: __________________________________________________________________

CONTACT INFORMATION
 Full Name: __________________________________________________________________
Address:___________________________________________________ Apt.#: ____________
City: ________________________________ State: _________________ Zip: _____________
Home Phone: (       ) ______________________ Work Phone: (       ) ______________________
Mobil Phone:  (       ) ______________________  Pager: (       ) __________________________
Email: ______________________________________________________________________

MEASUREMENTS
HEIGHT> Feet:  ______ Inches: _______ Weight: _______

COAT> Size: ______ Chest: _______ Chest/Wrap: _______ Coat Sleeve:_______

SHIRT> Size: ______ Neck: _______ Shirt Sleeve: _______

PANTS> Size: ______ Waist: _______ Outseam: _______

SHOE> Size:  ______ Shoe Width: _______

BOYS> Age:  ______ Pants Size: _______ Coat Size: _______  Shoe Size: _______ 

Remarks:____________________________________________________________________

BILLING INFORMATION

[   ] Visa

 [   ] Master Card [   ] American Express [   ] Discover/Novus [   ] Dinners Club/International [   ] Other
Card Number:

Exp. Date:   
 / 
Card Holders Name: ___________________________________________________________
Address:_____________________________________________________ Apt.#: __________
City: __________________________________ State: _________________Zip: ___________
Signature: ___________________________________________________________________


Valet Formal Wear Corporation, P.O. Box 11046 / Baltimore, Maryland 21212-0046 / www.valetformalwear.com / A Service Mark Corporation