Name
_________________________________________________________
Address 1 _____________________________________________________
*Address 2 _____________________________________________________
*(Religious organization or other non-profit status)
City ___________________________ State ______ ZIP _______- ______
Country __________________*
* Only if outside US check or (money order must be in US currency.)
Phone (optional) _____ - ____ - ________ Circle: Home or work
Earrings are non-returnable items
1" Chalice Pin Qty _______ X $9.95 each
= __________
1/2" Chalice Pin Qty ________ X $8.95 each = __________
1" Chalice Pendant Qty ________ X $9.95 each = ___________
(Pendant does not include a chain)
1/2"Earrings Post Qty ________ X $16.95 each = ___________
1/2"Earrings Wire Qty ________ X $16.95 each = ___________
Subtotal = $___________________
Shipping 1st Class = ____________
*7% RI Sales Tax = ________________
* RI residents only. (Provide nonprofit tax
exempt certificate if applicable)
Total amount enclosed: $___________
Make check or money order payable
to "Bell Street Chapel".
All orders must be prepaid. Shipping Cost For orders totaling:
$ 0 - $50 add $2.75
$51 - $150 add $4.50
$151 - $299 add $6.75
$300 -$500 add $9.00
Any questions about ordering, please call 401-273-5678