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Earthly Designs Order Form
Earthly Designs, 9393 York Settlement Road, N. Rose, NY 14516 
Tel. 315-587-9349

To order, you can call us directly or you can fax us this form.

To print this form, just select "Print" from your browser File menu and then fax it or mail it to us.
Ordered By-
Name:
Street:
City:
State:                                Zip:
Day Phone:		 Ship To-
Name:
Street:
City:
State                              Zip:
Day Phone:

Please Insert Item No., Brief Description and Metal Type if Applicable.

Item
No.

Description

 Sterling
Silver

24K Gold
Plated

14K Gold

Cost
. . . . . .
. . . . . .
. . . . . .
. . . . . .
. . . . . .
. . . . . .
. . . . . .

Thank you for shopping with Earthly Designs.
Our Fax Number is:
1-315-587-9349

 

Shipping & Handling Charge

 $6.50

Sub Total

 $

8.00% NY State Tax

 $

Total

 $

Check       WB01388_.gif (106 bytes)

Money Order       WB01388_.gif (106 bytes)

 Mastercard       WB01388_.gif (106 bytes)

VISA       WB01388_.gif (106 bytes)

Card Number

 |_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|      Add 3-digit Security Code from back of card:  _|_|_|

EXP. Date

 __/__/__ Phone: ( ___ ) ___-____

    Name of Card Holder (Please Print) ________________________

    Signature: ______________________________ Date:______________

Send Nancy an e-mail at: earthly@usadatanet.net
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