The Enchanted Gothic Jewelry Box Order Form

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If you are using your credit card. Please fill out all necessary fields on this form and then click the submit query button at the bottom. Or you can print the form, fill out all the info and mail it or fax it to:

The Enchanted Gothic Jewelry Box

C/o Mallory Strohl P.O. Box 4104 Jim Thorpe, Pa. 18229

"We do not accept personal checks!"

We accept cashier's checks, money orders, visa, mastercard, discover & american express!

Date

First Name

Last Name

Address

City

State

Zip Code

Country

Shipping Address: (If Different From Address On Credit Card!)

Phone Number

Email Address

Credit Card # (Visa or Mastercard Only!)

Expiration Date

Quantity Item Description Price Total

Quantity Item Description Price Total

Quantity Item Description Price Total

Quantity Item Description Price Total

Quantity Item Description Price Total

Quantity Item Description Price Total

Subtotal

(Pa. Residents add 6 % Sales Tax)

*Shipping & Handling

* All orders are shipped by U.S.P.S. Priority Mail at a charge of $4.95 per order!!

Total Other Comments:

Thanks for your order!

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*By clicking this button you will submit your order by email. Please note that some email programs cannot handle the submission of forms. In these cases you may have to send the form by regular mail or fax your order to us.