HEARTLAND RAINBOW PRISMS ORDER FORM
The Essence of ThingsTM
115 Baptist Road, Canterbury, NH 03224
Phone: 603-783-4782 Fax: 603-783-0427
| Name: __________________________________________________________________ |
| Phone: ___________________________ E-Mail _______________________________ |
| Street/PO Address:________________________________________________________ |
| City: _______________________________ State: ____________ Zip ________________ |
Please Send the Items Listed Below
|
Quantity
|
Item
|
Each
|
Sub-Total
|
|
#
|
Octagon Prism, Blue Beads
|
$ 17.50 | $ |
| # | Octagon Prism, Green Beads | $ 17.50 | $ |
| # | Octagon Prism, Lavender Beads | $ 17.50 | $ |
| # | Octagon Prism, Pink Beads | $ 17.50 | $ |
| # | Octagon Prism, Red Beads | $ 17.50 | $ |
|
#
|
Heart Prism, Blue Beads
|
$ 17.50 | $ |
| # | Heart Prism, Green Beads | $ 17.50 | $ |
| # | Heart Prism, Lavender Beads | $ 17.50 | $ |
| # | Heart Prism, Pink Beads | $ 17.50 | $ |
| # | Heart Prism, Red Beads | $ 17.50 | $ |
|
#
|
Teardrop Prism Blue Beads (not yet available)
|
$ 17.50 | $ |
| # | Teardrop Prism Green Beads (not yet available) | $ 17.50 | $ |
| # | Teardrop Prism Lavender Beads (not yet available) | $ 17.50 | $ |
| # | Teardrop Prism Pink Beads (not yet available) | $ 17.50 | $ |
| # | Teardrop Prism Red Beads (not yet available) | $ 17.50 | $ |
|
For purchases under $150 please include $7.50
shipping, handling and insurance charge. Purchases outside of the US require an additional charge There is a 10% restocking charge on returns. |
| Sub Total: |
__________ |
| Shipping/ Postage |
__________ |
TOTAL |
__________ |
| Payable by: Visa:_______ or Mastercard _______Card Number: ____________________ |
| Expiration Date: __________ Cardholder Signature: ______________________________ |
