Order Form

Mandatory fields**

**First Name **Last Name

**Email

Shipping Address

City State/Province Telephone Number

**Preferred contact time 6:00pm-9:00pm 9:00am-noon noon-3:00pm 3:00pm-6:00pm anytime

**Preferred method of contact email telephone

Please tell us if there are any colours that you dislike for the product
Would you like to purchase insurance yes no

Items Ordered

Pendants skull planet freestyle flow teardrop abstract flower coneshell mushroom deep sea coral tribal swirl pacific flower Colour spring summer fall winter amber purple blue moon caramel multi Quantity 0 1 2 3 4 5

Plugs drops claws talons Colour summer fall winter spring Gauge Size 6 4 2 0 00 Quantity 0 1 2 3 4 5