Mail in your order
print out the following order form and Mail it to:
Beverly Roberts
63 Columbus ave
Farmingville, NY 11738 |
Name:_______________________
Email:_______________________
Company (optional):____________
Address:_____________________
____________________________
City:________________________
State:_______________________
Country:_____________________
Zip:________________________
Phone:(____) _____-_______
(__) I am enclosing a check or money order for
$______
make all checks payable to Beverly Roberts.
(__) I want to charge this purchase to my credit
card.
(__)VISA
(__)Mastercard
Card Number: __________________
Expiry Date:____________________
Signature: ______________________
I authorize Patriotic-Jewelry.com to charge
this amount: ______________
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