Artbeads.com Fax or Mail Order Form

SHIPPING RATES FOR ANY SIZE ORDER (IMPORTANT: UPS will NOT deliver to a P.O. Box)

ORDERED BY / SHIP TO

First Name _________________ MI ___ Last ________________________
Street Address 1 ______________________________________________
Street Address 2 ______________________________________________
City _____________________________ State _____ Zip _______- _____

BILL TO (For credit card purchases, the address where your billing statements are received. Leave blank if same as above.)

First Name _________________ MI ___ Last ________________________
Street Address 1 ______________________________________________
Street Address 2 ______________________________________________
City _____________________________ State _____ Zip _______- _____
Daytime Phone Number (required) ( _ _ _ ) _ _ _ - _ _ _ _
Email Address (optional) ______________________________________

METHOD OF PAYMENT

Please Circle One: Cashier's Check / Personal Check / Money Order / Visa / MasterCard / Diners Club / Discover / AmEx
Account Number _____________________________ CCV#________
Expiration Date ________ / _________
Authorized Signature __________________________________