Name___________________________________________________________________
Address ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Remember to include Postal Code, Zip Code or country code)
Day Phone number (____) __________________
Night phone number (____) _______________
Fax number (____) ___________________
email address ____________________________________________________________
Method of payment:
q Certified Check (enclose with order)
q Money order (enclose with order)
q VISA (enter information below)
q Master
Card (enter information below)
Visa Master Card
Number _______________________________________________________
Expiration Date ___/___
Name as it appears on
card________________________________________
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Send order and payment to: Terra Cotta Pendants
1640 Route 114
Stoney Creek, NB,
Canada
E1J 1N9