Sample Printable Order Form (Wholesale):
To submit an order, please print this form and mail to:
Michelle Judaica and Jewelry
17920 Hartland Street.
Reseda, Ca 91335
Or Fax to:
818-996-1609
Please allow 1 to 6 weeks for shipping.
Items Ordered:
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shipping and handling |
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Total |
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For more items, please print and include a second form.
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Customer Information
*First Name ________________________
*Last Name ________________________
Company ________________________
*Email ________________________
Phone _________________________
Credit Card Information
*Card Type ________________________
*Cardholder’s Name As Shown On Card ___________________________________
*Card Number ______________________
*Expiration Date (mmyy) ____ / ____
*3 Digit Security Code _______________
*Required fields. |
Billing Address
*Address Line 1 ______________________
*City _______________________________
*State/Province _______________________
*Country _____________________________
*Zip/Postal Code ______________________
Shipping Address (if different from billing address)
Ship To Name __________________________
Address Line 1 __________________________
City reseda __________________________________
State/Province Ca __________________________
Country _______________________________
Zip / Postal Code _________________________
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Thank you for ordering from Michelle's Judaica and Jewelry. If you have any questions, please do not hesitate to contact us by phone at:
Tel:(818)335-3543,
Fax: 818- 996-1609,
Email at: michellejudaica@yahoo.com
