Order Form

Print out this form and fill out completely. When finished, mail to the address above
or fax to Beadstorm at 651/645-5745. You MUST include a daytime telephone
number and your Email address for your order to be processed.

Ship To

Bill To

Payment Type

Credit Card Info

[ ] Paying via Credit Card
[ ] Sending Money Order

We will contact you via Email and/or telephone with the total amount for your payment. OR, fill out the credit card information to the right to expedite your order.

Daytime telephone number _____/_____-________
Email address ____________________________

Credit Card Number
_ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
Expiration Date _ _ / _ _
CVV number (the three numbers from the back of the credit card) _ _ _

Name as listed on credit card:
_________________________________________

Signature (required)
_________________________________________

Part Number	Quantity	Item Description (size, color and shape if needed)

Do you have any special instructions for us (shipping, etc)? Be sure to note those on
the form also or include a second sheet of paper detailing your requests.