| Hemp Knot Style_____________________________ (If adding a rice vial, please fill out info above & see Hemp page) Please circle one Necklace/Choker Bracelet/ Anklet |
| Order |
| To order you can print and Fax this form to 719-372-0947 or email me to place an order. Methods of payment accepted: check, money order and cashiers check, payable to: Debra Walker. Contact me about paying with Paypal (Credit Cards Accepted). |
| Please circle one: Item description See items here Necklace Bracelet Anklet Key Chain Earrings |
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| Rice Jewelry Prices Number of characters 0-21characters 22-30 characters 31-40 characters 41-50 characters |
| Necklaces $15.00 $18.00 $22.00 $25.00 |
| Bracelets / Anklets $20.00 $22.00 $24.00 $25.00 |
| Key Chain $11.00 $13.00 $15.00 $17.00 |
| Earrings $22.00 $26.00 $29.00 $32.00 |
| Shipping & Handling |
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| My Paypal and Bidpay email payment address is [email protected] to item number is needed for payment |
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| Add $ 7.00 for 1st item $ 2.00 for each additional item |
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Method of Payment: Check Money Order Cashiers Check Bidpay or Paypal for Credit Card or Direct Check Payments (Make check payable to Debra Walker) Please provide me with your information: Please mail Check or Money Order with Order Form to: Name__________________________________ Debra Walker Address________________________________ c/o Rice Jewelry City___________________________________ State___________ Zip ___________________ Phone Number_(______)__________________ Email Address___________________________ Fax order to: 1-719-372-0947 |
| Item 1 What would you like written on your grain of rice? _____________________________________________________________________________ |
| Please circle one: Colored Sand, Glitter and Preserving Fluid Sand Purple Blue Green Yellow Orange Pink Glitter Opaque Silver Gold Color Fluid Clear Pink Blue Yellow Orange |
| Please circle one: Bead Style See styles here Fimo Levi Flower Multi Flower Purple Flower Green Flower Green & White Sunflower Red Flower Flames Dolphin Giraffe Cheeta Ying Yang Turtle Blend Blue Blend Green Blend Black Blend Purple Frosted Glass Red Blue Orange White Green Yellow Clear (Please note: Key Chains and Earrings do not come with beads.) See examples here |
| Please circle one: Glass vial style See styles here Clear Dolphin Colored Dolphin Bulb Cross Angel Cognac Bottle Elephant Froggy Piggy Heart Tusk Straight tube Sun Tea Pot Drill Tear Drop Fish (Please note: fish and drill come in assorted colors, email me to find out what colors are currently available) |
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| Temporarily Out of Service |