Bearclaw Jewelry - Order Form -

Fax number- 250-949-6920

Bearclaw Jewelry 
box 1174  Pt. Hardy 
British Columbia 
Canada . V0N 2P0
any questions phone us ( Marlene or Frank ) at 250 - 949 - 6921

Don't forget , depending on your type of order , make sure you give us all the information we
need to  contact you as well as article size , stone quality ,  metal preference or whatever needs to be mentioned
copy the form below to wordpad or MSworks or your word processor and print it. Fill it in and fax it to:

250-949-6920

Bearclaw Jewelry
Order Form -Fax # ---1-250-949-6920

Order #            Description                          Qty      Price /ea.   Total

_______l______________________________l_____l_______l_________
_______l______________________________l_____l_______l_________
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shipping  -----------registered Express--or---UPS

For regular express in Canada   - add  $ 12 ..... for UPS add $28........... For regular express in U.S.- add $20 to $25 - for UPS add $48..........   For regular express International  - add $48 - for UPS add $68

Total :_____________________

Custom requests Or Comments
____________________________________________________________
____________________________________________________________

Personal Information:

Name: _________________________________________________________________

Mailing Address_____________________________________________________
City,Province,(State),______________________________________________________
Country______________________________________
Postal Code (Zip):___________________________________________________
Phone: (_____)_-_(______-_________)
Fax:      (_____)_-_(______-_________)

E-mail Address:__________________________________________________

Method of Payment:

Money Order: ______________________________________
Visa: #____________________________________________

Mastercard # _____________________________________

Expiration Date:__________________________________
Name of Issuing Bank:_____________________________

Phone Number of Issuing Bank:_____________________________

Address where card was mailed to:_____________________________ Signature:__________________________________________

                        If it is to be sent to a different address then Send to :


Name: __________________________________________________________

Address:_________________________________________________________
 City, Province,(State), _______________________________________________

Postal Code  (Zip):__________________________________________________ Country:_________________________________

E-mail Address:____________________________________________________

Thank you

We will confirm all correspondence the moment we receive it