Chris White
770 NW Don
Madras, OR 97741
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EARRINGS ORDER FORM To Order: Print and mail this form to the above address with payment. Please allow 6 to 8 weeks for delivery. |
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SHIP TO: NAME: _____________________________________________________ ADDRESS: __________________________________________________ CITY: ______________________STATE: _______ ZIP: _____________ E-MAIL ADDRESS: ___________________________________________ Email address is for purposes of contacting you if there's a problem with the order. |
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ITEM / DESCRIPTION |
QTY |
UNIT PRICE |
TOTAL |
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Jacobs Ladder Version 1 Bead colors 1 __________ 2__________ |
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$ 6.00 |
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Jacobs Ladder Version 2 Bead colors 1 __________ 2 __________ |
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$ 6.00 |
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Jacobs Ladder Version 3 Bead colors 1 __________ 2 __________ |
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$ 6.00 |
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Jacobs Ladder Version 4 Bead colors 1 _________ 2 ___________ |
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$ 6.00 |
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Heart Bead color ______________ |
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$ 6.00 |
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Churn Dash Version 1 Bead colors 1 _________ 2 ________ 3 _________ |
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$ 6.00 |
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Churn Dash Version 2 Bead colors 1 _________ 2 ________ 3 _________ |
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$ 6.00 |
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Churn Dash Version 3 Bead colors 1 _________ 2 ________ 3 _________ |
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$ 6.00 |
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Tree Bead colors 1 _________ 2 ________ 3 _________ |
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$ 6.00 |
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Spinning Star Version 1 Bead colors 1 _________ 2 ________ 3 _________ |
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$ 6.00 |
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Spinning Star Version 2 Bead colors 1 _________ 2 ________ 3 _________ |
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$ 6.00 |
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Spinning Star Version 3 Bead colors 1 _________ 2 _________ 3 ________ |
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$ 6.00 |
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Sunny Lanes Version 1 Bead colors 1 __________ 2 _________ 3 ________ 4 ___________ |
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$ 8.00 |
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Sunny Lanes Version 2 Bead colors 1 _________ 2 _________ 3 ________ 4 ___________ |
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$ 8.00 |
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Ohio Star Version 1 Bead colors 1 _________ 2 _________ 3 ________ |
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$ 8.00 |
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Ohio Star Version 2 Bead colors 1 _________ 2 _________ 3 ________ |
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$ 8.00 |
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Shoo Fly Version 1 Bead colors 1 _________ 2 _________ 3 ________ |
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$ 6.00 |
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Shoo Fly Version 2 Bead colors 1 _________ 2 _________ 3 ________ |
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$ 6.00 |
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Shoo Fly Version 3 Bead colors 1 _________ 2 _________ 3 ________ |
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$ 6.00 |
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SUB - TOTAL |
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SHIPPING & HANDLING |
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TOTAL |
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PAYMENT METHOD: Money Order _____ Certified Check _____ |
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SHIPPING AND HANDLING COSTS
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$ 0.00 to $ 9.99 |
$ 2.00 |
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$ 10.00 to $ 49.99 |
$ 5.00 |
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$ 50.00 to $ 99.99 |
$ 10.00 |
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$100.00 to $199.99 |
$ 15.00 |
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$200.00 and over |
$ 20.00 |
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Gold ___, Silver ___, |
Pierced ___, Clip on ____ |
If ordering more then one of each pair please list them by name with your choices below here or on the back of the order form.