Print out this form and follow the directions.

STEP ONE: fill out contact info

NOTE: PLEASE PRINT VERY CLEARLY. We cannot fill your order if your entries are not clearly written.

Name:

________________________________________________

Shipping Address:

________________________________________________

Email Address:

________________________________________________

Phone Number:

________________________________________________

STEP TWO: select pins and add up your total

ITEM

QUANTITY

PRICE PER PIECE

SUB TOTAL

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

       

 

Choose a shipping method and add to total

US First Class Mail

$2.00

 

US Priority Mail

$5.00

 

TOTAL

(                )

NOTE: 8.25% sales tax may be applied to California-based credit card orders.

STEP THREE: select payment method

Check - Make check out to Delta Spark

Credit Card - fill in the info below

Name on Card:

________________________________________________

Billing Address:

________________________________________________

________________________________________________

Card Type:

Card Number:

________________________________________________

Expiration Date:

________________________________________________

Card Verification #:

________________________________________________

The card verification number is a 3-digit number for Visa, Mastercard and Discover and a 4-digit number for American Express. (See examples below) We cannot process credit card payments without it.

EXAMPLE: Visa, MC and Discover

EXAMPLE: American Express

Signature:

________________________________________________

STEP FOUR: check on availability

If you have printed out this form and held on to it for more than a day, please go to www.peacepins.com and make sure your selections are still available. This form does not reflect our weekly specials. Please note the special you are taking advantage of.

STEP FIVE: mail

Send this form and check or credit card information to: