Accents Beads Order Form

Accents Beads Order Form

Accents Beads
12112 Nebel Street
Rockville, MD 20852
Phone: 301-881-2003 Fax: 301-881-5680

Mail Completed form to: orders@accentsbeads.com Use the TAB KEY to move between fields.
Please read our ordering info before completing the order form.

Customer Information Red Fields are Required
Email:	For UPS tracking data and shipping date.
Name:
Address:	Apt. #:
City:
State:	Zip:
Country:
Phone (DAY):
Phone (Evening):

Order Information Red fields are required
	Quantity	Description of the item	Unit Price	Total
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Subtotal:
Shipping & Handling: UPS Ground
MD orders only: 5% Sales Tax
Total:
Prices are subject to change without notice.

Payment Information
Please choose a payment method: Visa Mastercard Discover
Credit Card Number:
Expiration Date (mm/yyyy):
Card VIN Number:	(3 digit code on the back of your credit card)
Name on Your Card:
Note: This form is NOT secure.
Shipping Charges: Our minimum shipping and handling charge is $8.50. There is no minimum order. If you want a copy of your order please print it out before hitting the submit button.