STUDENT INFO

Last Name .. First Name

Address City State Zip

Phone Email

______________________________________________________
TUXEDO OPTIONS PLEASE MARK BELOW

SCHOOL NAME: Fresh Soph Jr Sr

Band Choir Orchestra

Option A $119
Option B $59.50
New Shirt $20
Used Shirt $15
Cummerbund $7
Bow Tie $3
New Shoes $49
Used Shoes $30
Garment Bag $15

Shoe Size

ORDER TOTAL - REMEMBER TO INCLUDE TAX 8.05%

AMOUNT TO CHARGE $:

PAYMENT CARD VISA MASTERCARD DISCOVER


CARD # EXP CCV

**FOR RENTALS ONLY -- By clicking this box, I agree to return the tuxedo to LeSueur’s Tuxedos by the last day of school. If not returned on time, I agree to allow LeSueur’s Tuxedos to charge my credit card $5.00 per day late fee up to the full purchase price of $119.

 

I agree to rental terms