MINI JEWELS TACK					1717 W. Yearling Ave.
					Phoenix, AZ  85085
ORDER FORM					602-695-3903  or Fax
					1-623-434-1814
Please print out this form and fax to:  623-434-1814
NAME:_______________________________________				DATE:___________________________
ADDRESS:_____________________________________
CITY:___________________ STATE: ______  ZIP:  ____________				NEEDED BY:___________________________
DAY PHONE #_______________________________
Qty.	Item#	Item Description	Size	Color	Hardware	Rate	Total
					Merchandise Total
METHOD OF PAYMENT
COD or Visa/Mastercard (Please Print Clearly)
#:  _________________________________ Exp. Date:  ________				NAME:_________________________
___________________________________________________				ADDRESS:_____________________
CARDHOLDER'S SIGNATURE				CITY:__________________________
				STATE: ______		ZIP:  _________