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Your Order Information:
Your Name
Address
City
State
Zip Code
Phone Number
E-mail Address
Shipping Info (if different):
Name
Address
City
State
Zip Code
Above information only needs
to be filled out if different
from the order information
CLICK THE CHECK BOX FOR ITEMS ORDERED
Gemstone with Austrian Crystal Birthstone Item#_MGACB1.
Mothers Bracelets Selection for ITEM# MGBACB1
Mothers Bracelet Personalization:
Name 1.
Name 2.
Name 3.
Name 4.
Name 5.
Please,
put the names you want
in birth order if you want them
in birth order. PLACE 0 in the field that you are not using
Payment By Credit Card
Order Total Amount $:
Card Holder
Card Number
Expiration
I authorize you to charge the above
stated charge account for the above
selected items in the amounts shown.
I hereby understand that the company
CREATIVE JEWELRY will be printed on
my monthly billing statement. Please make sure the form is complete and accurate.


TO
ORDER
BY
SNAIL_MAIL:

SEND PERSONAL CHECK, MONEYORDER OR CASHIER CHECK WITH YOUR COMPLETED ORDER TO:

CREATIVE JEWELRY

27 JULIE LANE

ST PETERS,MO. 63376

Allow 3 to 6 weeks for delivery on snail mail orders.

For faster service of 1 to 3 weeks delivery copy and paste the order form and e-mail the form to the address below(Orders are shipped only after payment has been received.)

Send order to:[email protected]>

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