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| SHIPPING ADDRESS:
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$ |
$ |
| STREET: | Sub-Total |
$ |
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CITY: STATE: |
Email Discount Code #__________ _____%: |
$– | ||
PA and OH Residents |
Add 6% Sales Tax
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$ |
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| U.S. Shipping and Handling - add $3.50 U.S. Overnight - add $15 |
Shipping & Handling
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$ |
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 We Accept PayPal
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TOTAL |
$ |
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| FOR NAME BRACELETS: PRINT NAME : ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ | ||||
| FOR MULTIPLE NAMES ATTACH SEPERATE SHEET. | ||||
| PHONE,
FAX, OR MAIL YOUR ODER TO ONE OF OUR DESIGNERS: |
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NANCY BACKNER
2376 ARLINGTON AVENUE COLUMBUS, OH 43221 TEL: 614-486-9314 FAX: 614-486-3184 EMAIL: NANCY@BEADALS.COM |
SUSAN COOK
1043 BALMORAL WAY MAPLE GLEN, PA 19002 TEL: 215-643-0732 FAX: 215-643-0732 EMAIL: SUSAN@BEADALS.COM |
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| Credit Card Information: | 
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| Name on Card:_______________________________ | Exp. Date:________ | Amount $________ |
| Card #___________________________________ | Signature: _________________________________ | |
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eMail:_______________________________________________ |
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