| Please
fill out your personal information: |
| Date: |
| Your
Name: |
Address: |
| Phone: |
| Email
Address: |
Photo
Bracelets |
Price |
Qty |
Total |
Horizontal
Silver Photo Bracelet Size 7" |
20.00 |
|
|
Horizontal
Gold Photo Bracelet Size 6.5" |
14.99 |
|
|
Horizontal
Gold Photo Bracelet Size 7" |
14.99 |
|
|
Vertical
Silver Photo Bracelet Size 7" |
20.00 |
|
|
| Vertical
Silver Photo Bracelet Size 7.75" |
20.00 |
|
|
Vertical
Gold Photo Bracelet Size 7" |
14.99 |
|
|
| Vertical
Gold Photo Bracelet Size 7.75" |
14.99 |
|
|
5
Charm Photo Bracelet Size 7.25" |
25.00 |
|
|
| Limited
Edition Breast Cancer Awarness Bracelet Size 8" |
25.00 |
|
|
Photo
Resizing Service |
10.00 |
|
|
|
SUB TOTAL: $______________ |
Colorado
residents please add 7.70% sales tax: $______________
Add
Shipping: $3.85
|
GRAND
TOTAL: $______________ |
Payment
Information: |
Credit
Card Type |
Credit
Card Number |
Expiration
Date |
| __VISA
__ MasterCard __Discover |
_____________________ |
__
/ __ / __ |
| Signature:
|
_________________________________
|
| Please
mail this completed form to: Generation Scrap, LLC., 1354 South
Quintero Way, Aurora, CO 80017 THANK
YOU! |