Premier Designs Jewelry Order Form

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					             Premier Designs Jewelry Order Form
Name:_____________________________________________________
Address:___________________________________________________
City:________________________State:__________ Zip:___________
Home:________________Cell:_______________Other____________
Email address:_____________________________________________
   Would you be interested in having a fun fashion jewelry show and receiving
    $200-$300 in FREE JEWELRY?
     _____ YES                 _____ Maybe                  _____ NO
   Would you like to be on my mailing list for specials?
     _____ YES (E-mail or Snail-mail?)                     _____ NO
   Would you like to receive more information about the business opportunity
    with Premier Designs?
     _____ YES                 _____ Maybe                  _____ NO

              SPECIAL: BUY 3 ITEMS & YOU MAY PURCHASE
                        A 4TH ITEM FOR ½ PRICE!

    Item #    Size Qty Page                    Item Name                    Each     Total




Thank you for your order!!!
                                                                         Total:      _______
Please make checks payable to: Cookie Strickland                         Shipping:      2.50
(407-929-6496; cookiestrickland@yahoo.com)
I accept Visa, MasterCard, Discover & AmEx                               Subtotal:  ________
Card# ___________________________________                                + Tax      ________
Exp. ____________ Zip Code: _____________                                Total Due: $_______