The Rose Jewelry Order Form

The Rose Jewelry Order Form
Customer Information
Full Name

First NameLast Name
E-mail
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Items Ordered

Please be aware that the color of jewelry will vary depending on type of flowers used.
Please list the item number, Quantity, Color and Size for Each Item you are ordering in this box.
If you have any comments or specific questions please ask here and we will get back to you in an email of by phone.
Delivery and Payment

Please write Checks Payable to Linda Whitmire. Please print a copy of this form if possible and send with order.
Total amount of check mailed
Delivery Options

Mail order to me regular US Post $ 4.00I will pick up at Georgiana's Place no shipping.Call when finished to discuss shipping
Refund Policy

Due to all order materials being purchased with your payment we are unable to give refunds as each order is custom. .
Should be Empty:

Customer Information