Beadwork Creations PAS Bracelet Order Form 1

Name______________________________________________
__________________________________

Street Address____________________________________________State___________Zip___________

Phone______________________________Email Address______________________________________
Confirmation of receipt of your order and payment will be sent via email or phone call.

Select your bracelet type Bracelet Type

_____Swarovski  Crystal and sterling silver bracelet with toggle clasp

_____Swarovski  crystal and sterling silver bracelet with spring ring clasp

_____Medical Alert Bracelet with Swarovski  crystal and sterling silver lobster claw clasps

________Wrist measurement in inches at the point on your wrist where you would wear your bracelet

Select the Crystal Color for your bracelet

____”PAS” Pink ____”PAS” Blue

____Garnet ____Amethyst ____Aquamarine ____Crystal (clear)

January February March April

____Emerald ____Light Amethyst ____Ruby ____Peridot

May June July August

____Sapphire ____Rose ____Topaz ____Blue Zircon

September October November December

Capital
Select Name or Initials letters
that you want for your bracelet

_____”PAS” _____”DAUGHTER” _____”SON”

_____Child’s Name or Initials ___ ___ ___ ___ ___ ___ ___ ___
Limit of 8 letters. Please print clearly

Select TypeSelect Type

of Letter of Letter
Blocks you Block
want for your bracelet
_____Sterling Silver _____White resin block _____Colored resin block
with colored letter with black letter

NOTE: Color of resin block and letter on white block will vary.

Select any extra Items you want on your bracelet

Can be placed before or after name or initials

_____Sterling silver block imprinted with stick figure girl Cost $3.75

_____Sterling silver block imprinted with stick figure boy Cost $3.75

Select Medical Alert Tag if you are purchacing

 Select Medical Alert Tag if you are purchasing a Medical Alert Bracelet
Beadwork Creations PAS Bracelet Order Form 2

____Asthma ____Bee Stings ____Blood Thinner ____Cancer ____Coumadin

Patient
____Diabetes ____Diabetes l ____Diabetes ll ____Gastric ____Heart Patient
Bypass
_____High Blood _____Latex ____Lymphedema ____Memory ____Pacemaker
Pressure Allergy Impaired
____Peanut/Nut ____Seizure ____Sulfa ____Blank Tag
Allergy ____Penicillin Disorder Allergy (Suitable for
engraving)

PRICE LIST

UP to 71/2 inch bracelet COST 7&3/4 to 9 inch COST

with: bracelet with:
3 letter name or initials $ 29.00 3 letter name or initials $ 30.00

4 letter name or initials $ 32.00 4 letter name or initials $ 33.00

5 letter name $ 35.00 5 letter name $ 36.00

6 letter name $ 38.00 6 letter name $ 39.00

7 letter name $ 41.00 7 letter name $ 42.00

8 letter name $ 44.00 8 letter name $ 45.00

Medical Alert Tag $14.00 Sterling Silver Boy or $ 3.75

Girl Block

Bracelet Total $__________

Medical Alert Tag Total $__________

Sterling Silver Boy or Girl Block Total $__________ 10% of the sale of
each bracelet will
Sub Total $__________ be donated to
PAS.
Shipping $______3.75_
.
7% TAX is ONLY for NJ residents TAX $__________

ORDER TOTAL $__________

Payment must be received with your order. Checks imprinted with your name & address, money orders or
Cashier’s checks gladly accepted.
PLEASE MAKE PAYABLE to Linda A. Waller.
Remember to Send your order with payment to:
include your Linda A. Waller, 353 Boulevard Avenue, Pitman, NJ 08071.
wrist Questions??? Call 856-582-8617 or lindawaller35@comcast.net
Measurement
!