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
14 kt.gold Mothers Bracelet Item #MBGFB3.
Mothers Bracelets Selection for ITEM #MBGFB3
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 aren't 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
SGM Distributing 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.)

<~~~ CLICK HERE TO USE THE ONLINE CHECK SERVICE.

Send order to:[email protected]