Directions:
- PRINT This is a form to be printed and filled out
- FILL OUT Be sure to include your name and address
- MAILTo the address at the bottom of the page
Thank you for your order!
Order Form:
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| Your Name | |
| Address 1 | |
| Address 2 | |
| City/Town | |
| State | Zip |
| Email* | |
| Phone* | |
*The Email and Phone will help me
communicate with you.
I DO NOT pass on this information to third parties *
| Item | Price | Quantity | Total |
| Sunny Day | 30.00 | ||
| Swinging on a Star BLUE | 35.00 | ||
| Swinging on a Star AURORA BOREALIS | 35.00 | ||
| LARGE 40 mm Swinging on a Star | 38.00 | ||
| SMALL Sitting on Top of the World (30mm crystal) | 38.00 | ||
| LARGE Sitting on Top of the World (40mm crystal) | 45.00 | ||
| The Christmas Pickle Ornament | 58.00 | ||
| Mouse Ring ~ Sterling..........SIZE | 25.00 | ||
| Mouse Ring ~ 14K Gold..........SIZE | 115.00 | ||
| Lover's Puzzle Ring ~ Sterling..........SIZE | 85.00 | ||
| Lover's Puzzle Ring ~ 14K Gold..........SIZE | 795.00 | ||
| Conscience Earrings ~ Sterling | 65.00 | ||
| Conscience Earrings ~ 14K Gold | 295.00 | ||
| SUBTOTAL | |||
| Virginia Residents must add 5% state sales tax | |||
| Shipping..... For orders UP TO $100 add 6.15 For orders OVER $100, click on the link to go to a shipping calculator |
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| TOTAL | |||
I accept checks, which must clear, and Money Orders
Please print this form and mail with payment to:
PD CROWE ~ JEWEL GARDEN
12152 Beaverwood Place
Woodbridge, VA 22192
I'd prefer to use the CCNOW Credit Card Format
I'd prefer to use my PAYPAL account