Leather Jewelry - Order Form

Leather Jewelry Order Form

Please Mail to:
Lin Marie Originals, LLC
P. O. Box 2614
Monroe, MI 48161

You may type your information in the fields below, then print using your browser's print option.

First Name:

Last Name:

Primary Address:

City:

State:

Zip Code:

Shipping Address, if different from Primary Address:

City:

State:

Zip Code:

E-Mail Address:

Day Phone:

Evening Phone:

Credit Card #:

CVV Security Code:

Expiration Date:

Select type of Credit Card:
Visa
MasterCard
Discover

Credit Card billing address, if different than Primary Address:

City:

State:

Zip Code:

Please PRINT your order below.

Item                                                                                                                 Qty.        Price        Ext. Price

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                                                                                                               Subtotal _____________

Please make checks payable to:                           * Michigan Residents Only + 6% Tax ___________

Lin Marie Originals, L.L.C.                                                                                     Shipping __________

                                                                                                                 Total _____________

Shipping Rates Continental U.S. Only

$0.01	$28.00	$3.00
$28.01	$40.00	$4.00
$40.01	$60.00	$5.00
$60.01	$149.99	$6.00
$150.00	& UP	FREE