Floral Swirls Order Form

1551 E. Via Mirasol Lane
Fresno, CA 93730
Tel: (559) 440-0928
Fax: (559) 451-0279
info@floralswirls.com

Bill To:	* required fields
Name: *
Address: *
City: *
State: Zip: *
Phone:
email: *

Ship To:

Name:

Address:

City:

State: Zip:

Phone:

email:

This is a gift **

** If Gift is checked,
Shipping data is required.

Do not send any money, yet! We will enclose an invoice with your order.
Send us a check when you receive your lovely Floral Swirls.
If you have selected the gift option, Floral Swirls will be sent to the shipping
address and the invoice will be sent separately to the billing address.

Swirl Description	Quantity	Cost	Item Total
Topaz on Gold Swirl		$ 8.00
Aquamarine on Gold Swirl		$ 8.00
Assorted Gold Bead on Gold Swirl		$ 8.00
Assorted Silver Bead on Silver Swirl		$ 8.00
Green Crystal Cut Bead on Silver Swirl		$ 8.00
Amber Crystal Cut Bead on Gold Swirl		$ 8.00
Pink Crystal Cut Bead on Silver Swirl		$ 8.00
Clear Crystal Cut Bead on Silver Swirl		$ 8.00
Gold Ball on Gold Swirl		$ 6.00
Silver Ball on Silver Swirl		$ 6.00
Clear Drizzle Bead on Silver Swirl		$ 9.00
Any Comments or Questions?	Sub Total :
	Sales Tax :
	Shipping :
	Grand Total :