Please print out this form, fill out, sign, fax or mail in.
If you choose to submit this form via email, leave the credit card number out
and we will contact you over the phone. A Final confirmation will be emailed to add the tax & shipping/handling if needed. This also is in case clients want to alter/change the size of the item.

Name:
Billing address:
City, State, Zip:
Shipping address:
City, State, Zip:
Phone:
Email:

USD currency cash, Western Union or United States Postal Money Orders only.
No checks, money orders, Postal money orders or bank checks
drawn on a source outside the USA.

 

Item number	Type (necklace, bracelet, earring, etc)	Quantity	Price

 

Tax

FL residents only 7.0% sales tax

Click one	Check MasterCard VISA Discover American Express
Credit Card		Exp Date
Comments /Special Orders
Signature		Date