Beadifulgems-Order Form

Use this page to order by mail, email, or phone.

	Shipping Information (if different than Billing)
Name	Name
Address:	Address:
City: State: Zip:	City: State: Zip:
Country:	Country:
Daytime Phone:	Daytime Phone:
Email:	Email:

COMMENTS: If ordering name bracelets, be sure to include names and specifics to each item.

PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO: Vicki Johnson
Vicki Johnson 4171 LaRue-GreenCamp Rd. Marion, OH 43302 United States	Phone: 740.528.2558 Fax: 740-528-2738 vjohnson@beadifulgems.com

Name on Credit Card:

Billing Address:

Visa

MasterCard

Number:

Expiration Date: