Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
URL

Choose style:

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

Please choose size:

13 inch
14 inch
15 inch
16 inch
17 inch
18 inch
Other   

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

                                         Clear lined with blue                
Clear lined with green

Clear lined with yellow                 Clear lined with red 

Clear lined with brown                 Green 

Japanese miracle beads (choose color)

Other                                  

Please choose type of charm:

Glass mushroom teardrop
Antique pewter serpent
Antique pewter frog
Antique pewter arrowhead
Antique pewter feather
Silver whale tail
Silver 4 leaf clover
Silver Chinese dragon
Pewter cannabis leaf
Zodiac (specify sign) 
Letter Beads (specify letter/s) 

Any additional comments or instructions:

*Shipping and handling fee $1.50 per item.

Total Price enclosed:    

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