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QUEEN ANGEL EARRINGS ORDER FORM

Retailers Only -To place an order:
US MAIL, PHONE: 828-779-1569,  FAX: 828-628-3378 or EMAIL
Terms: Net 30 Days  Shipping: Fed Ex Ground

Or Pay Now By: Credit Card or Check (Make payable to Lee Pantas)
Mail To: Lee James Pantas, Cherry Orchard Studio,
                      18 Garren Mountain Lane, Fairview, NC 28730

__Visa/MasterCard  __American Express

                               

Exp. Date _________   Zip Code Associated With Credit Card_________

Name of Cardholder: __________________________________________

  Billing Address

           Ship To: (If different than billing)                     

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Store/Company
     NAME:		    
Address:    
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City/State/Zip:    
Contact:   ///////////////////////////////////////////////////////////////////////////////
Phone:   ///////////////////////////////////////////////////////////////////////////////
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MINIMUM ORDER 12 PAIRS:
GOLD ONLY AVAILABLE AT THIS TIME