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Anklet Order Form

Instructions: Please print this form and mail with check or money order to:

Shelle's Hemp Haven

c/o Roshelle Day

244 SW Rimrock Way #4

Redmond, OR 97756


(Make check or money order payable to Roshelle Day. For those sending checks, items will not be started until check clears the back.  $25 charge for bad checks.) 


Use a separate order form for each item. Up to 5 items may be ordered at one time.



Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
Zip/Postal Code
Work Phone
Home Phone

Choose style:

Style A
Style B
Style C
Style D
Style E
Style F

Please choose size:

child (specify size)
10 inch
11 inch
12 inch

13 inch

14 inch


Please choose one or two colors of hemp:

Natural  Purple   Blue     Red    
Green    Yellow   Black    

Please choose bead color (one or two):

Metallic Blue                          Metallic Purple   
Green                                  Clear lined with blue                
Clear lined with green                 Clear lined with yellow  
Clear lined with red                   Clear lined with brown               
Japanese miracle beads (choose color)  Other                                  

*If you want a charm, please specify from the charms on the choker list.

Any additional comments or instructions:

**Shipping and handling - $1.50 per item.

Total Price enclosed:

*Print this form and mail with check or money order to address above.

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Shelle's Hemp Haven
Copyright 1999 Sacred Dreams Web Design. All rights reserved.
Revised: July 18, 2001