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Belladonna Jewellery Inc.   Date:_____________ P.O.#:_____________
30 Capstan Gate
Concord, ON
L4K 3E8 Canada
Tel.: +1 (905) 882-8600
Fax: +1 (905) 886-1667
www.belladonnacanada.com
info@belladonnacanada.com
 
   
Buyer:___________________________________
  		  Ship to:___________________________________
 
Bill to:___________________________________
  		  Tel:___________________Fax________________
 
Tel:________________Fax__________________
  		  Full address:_______________________________
 
Full address:_____________________________
  		  _________________________________________
 
_______________________________________   _________________________________________

Salesperson:

 Start Ship: Complete By:
Quantity Style No. Description Price Total
         
         
         
         
         
         
         
         
         
         
         
         
    Grand Total:  
Please complete this form and fax it back to: 1 (905) 886-1667
 
  • In case more than one colour is required in an item, the colours should be mentioned from exterior to interior (exterior colour first and center colour last).
  • For the Rose Garden Collection (RGC), the colour of the rose should be mentioned in addition to the prior instruction.
  • All prices are in U.S dollars, and do not include shipping and applicable taxes.
  • COD Charges: $9.00
Terms
  COD
  Credit Card

        card number: ________________________________

            expiration:  ________________________________

Signature: _____________________________________

Remarks: _____________________________________