Starstone Printable Order Form
This section is required for the person who will wear the starstone necklace:

First Name:

Birthdata:
Month:
  		Day:
  		Year:
  		Hour: (specify noon/midnight)
Minute:(00 - 59)

Birthplace:
City:
 State or Province:
 Country:

Please circle your choices:

Chain Length:

Ship To:

Name:
 Address:
Bill To:

Your Full Name:
 Invoice Number:

Payment Options:

Visa
Money Order
Personal Check
I have paid through Paypal
 Visa #:
 Expiry Date:

Custom Starstone Necklace:
$75.00 each US

Coupon #:

Orders will be filled when payment is processed.

Comments:

MAIL OR FAX TO:

Mailing Address:
A STONE'S THROW
BOX 147
ARMSTRONG, B.C.
CANADA  V0E 1B0

Phone: 1-250-546-8891
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