Collie's Custom
J E W E L R Y                                             ORDER FORM
                            (please print form and mail to address below along with payment)

Name: _________________________________________________________________________


Address: _______________________________________________________________________


City: __________________________________  State: _________  Zip: _____________________


Phone #: _______________________________ E-mail: __________________________________


Quantity                        Item # and/ or description of item you are ordering:                                                     Price:   

______                1) _________________________________________________________                ____________

______                2) _________________________________________________________                ____________

______                3) _________________________________________________________                ____________
      
______                4) _________________________________________________________                ____________

                                                                                                             Subtotal:                                ____________
                                                                                                        
                                                                    (California residents only)  Tax 8.25%                            ____________

                                                                                              Add $5.00 Shipping:                             ____________
                                                                                  (free on orders over $75.00)
                                                                                                                                                                  
                                                                                                               TOTAL                                $____________

Do you have any special instructions for us, such as a change in length of necklace or bracelet?  If yes, please list any
special instructions below:
_____________________________________________________________________________________________


_____________________________________________________________________________________________


_____________________________________________________________________________________________

Please make check payable to Collie's Custom Jewelry.  Please send payment, along with completed order form to:

Collie's Custom Jewelry
P.O. Box 1714
Thousand Oaks, CA 91358

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