www.ShyBodyJewelry.com Mail in Order Form                            Date:____________________

Payment Options - Money Orders Only

Shipping information                Items with * are required.

*Contact Person: _________________________________________________*Phone #:__________________
*Street Address:_________________________________________________
*City:____________________________________   *State:____________   *Zip Code:____________________
  Email Address:_________________________________________
       (if you would like email verification of order received & shipment please include your email address)        

Item ID#

Example
Item Name / Description
Choices & Options
Quantity
Price
Sub Total
ID# 312
14G Gem Captive Hoop
Purple
2
$3.50
$7.00
































































































           Free Shipping with $50 Purchase!!


Please mail Money Orders & Make Payable to:

Shilo Davenport                    
N13154 Cardinal Ave                    
Owen, WI 54460                
   Thank you                
   www.ShyBodyJewelry.com                

Sub Total

Shipping
$6.99
Total

Available for Orders within the United States Only!