Fax, Mail and Phone Order Form

Fax to 781-934-8775

Mail to:
Seaside Originals
P.O. Box 1417
Duxbury, MA 02331

Please make checks/Money Orders in US funds and payable to Seaside Originals.

 

Please indicate purchase by the dozen (SS 34 only) in the quantity box with a /d.
For example:  A dozen round crystals
1/d = dozen price

 
QUANTITY
STONE SIZE
DESCRIPTION/COLOR
PRICE

TOTAL

 
         
         
         
         
         
         
         
         
         
         
         
         
         
Subtotal: $
Shipping: $5.00
Tax (MA residents) 5%
TOTAL: $

 

 

PLEASE PRINT LEGIBLY!
YOUR NAME:  
ADDRESS:  
CITY, STATE, ZIP:  
CREDIT CARD MASTERCARD___        VISA___ 
CARD NUMBER:
__   __   __   __ - __   __   __  __ -__   __  __  __ - __  __ __  __
CARD EXPIRES:
MONTH:____ YEAR:_____
SIGNATURE
(REQUIRED FOR CREDIT CARD ORDERS)
___________________________________________________
E-MAIL (OPTIONAL)  
PHONE  
If we have your e-mail or phone and there is a snag with the credit card, it's easier to reach you. Please do supply one... we NEVER share this information.
DATE:

QUESTIONS OR COMMENTS: