JewelryVilla.com ORDER FORM FAX TO 928-569-2788

Tin Head Designs, P.O. Box 443, Green Creek, NJ 08219 E-mail: Sales@jewelryvilla.com

Toll Free Telephone: 1-877-218-5786

Print this form by clicking on the print button on your computer BACK to JewelryVilla

ORDERED BY			SHIP TO
Name			Name
Address			Address
City, State, Zip			City, State, Zip
Phone			Phone
E-mail			E-mail
Qty	Item Number	Description		Unit Price	Total Price
				Sub Total
				Sales Tax (7% for NJ only)
				Shipping
				Total

Payment Method:

· Credit Card (fill in Credit Card Info Below)

· Money Order (Make Money Order Payable to Tin Head Designs)

·

·

· Cash (Tinhead Designs will not be held responsible for any cash lost in the mail. We suggest that you send Cash by certified mail.)

CREDIT CARD INFORMATION

Name on Card: ____________________________

Number: _________________________________

Type of Card _____________________ : _______________ Expiration Date____________

Signature: ________________________________

Date _________________

This form can be mailed to the address above or fax to 928-569-2788