Mail Order Form

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Please print out this page and include the necessary information to make your purchase by mail, include your check and mail to the address below. 

 

Item Description Gift Wrapping? (please circle) Special Instructions? Cost
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  
  Yes/No  

Coupon Code

  

 Total 

   
Shipping    $5.00
Grand Total     

 

 

Your Name: _________________________________________________________

Your Address: _______________________________________________________

City/State:__________________________________________________________

Country:____________________________________________________________

Phone:_____________________________________________________________

Please note, your information will never be passed on to a third party, the above information is required for confirmation of order and shipping.

 

Please mail your order and check to:

Kiwi Jewels

6863 State Route 408

Mount Morris

NY 14510

Ph: 585 298 8690

 

 

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