Please Print Out This Form
 

 

Ship Order To:

PO#:______________

Name of  Business:________________________

Resale#:___________________NY Only

Name of  Individual:________________________

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Street Address:___________________________

Phone  #:_________________

City:_________________   State:_______

Zip:__________

Credit Card#____________________________

Verification Code: _____ (3 Digits in back)

Signature: ___________________________________

Ex.  Date:_______________

Item #

Quantity

Colors

Description

Each Price

Total  Price

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Email Order To: order@shiningbeads.com
Fax Orders To: (435) 304-1055

Subtotal

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8.25%  tax
NY only

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Shipping

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Total

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