ORDER FORM Please Fill In Then Print This Form To Order By Fax or Mail! * Please Provide The Following Contact Information: First Name:   __________________________________ Last Name:   __________________________________ Middle Initial:   __________________________________ Street Address:   __________________________________ Address (cont.):   __________________________________ City:   __________________________________ State/Province:   __________________________________ Zip/Postal Code:   __________________________________ Country:   __________________________________ Work Phone:   __________________________________ Home Phone:   __________________________________ FAX:  __________________________________ E-Mail:   __________________________________ URL:  __________________________________ *Please Provide The Following Ordering Information: Quantity Gift Style Size Price                                                         Quantity Decor Style Size Price                         Quantity Celtic Jewellery Item # Price                         SUBTOTAL:   NY TAX:   TOTAL:

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