Bands Order Form

 

Name:____________________

Phone #:_(___)_____-_______

Address:___________________

City/State:___________/______

Zip:_________ Qty:___(limit 4)

Delivery Date:_____/_____/_____

Options:

q  Necklace

q  Bracelet

Delivery Options:

q  Airborne

q  Ground

q  Overnight

q  Express

Payment: CASH ONLY

Total:$____.__

Colors:_____________________________________