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Order Form
PLEASE MAKE CHECKS PAYABLE TO:
MONICA A. GALLEY-KELLER
Name:_____________________________________________________________________
Address: ___________________________________________________________________
City:_______________________________________ St.__________ Zip:_______________
Ph:_____________________________ Cell/other:__________________________________
Method of Payment: Cashiers Check Check* Paypal Master Card Visa
Email:______________________________________________________________________
Breed:________________________________
Item: Pin Pendant Bracelet Earrings Necklace Fan Pull Lamp Finial Ornament Hanger
Custom:_________________________________________________________________
Metal Tone: Gold Silver
Sculpture colors:___________________________________________________________
Additional Information:______________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Please cut and paste this form and email or snail mail to:
petsbejeweled@aol.com
Pets BeJeweled, 141 Seminary Avenue, Greensburg, PA 15601
* Orders will be shipped after 7 business days to process personal and business checks.
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