Order Form for Contemporary Style Pendant

Pendant Order Form (LE):   704-574-1815           www.DanielNie.com 

Your Name:__________________­­­­­­­­­­­­­­­­­­­­_____________Tel#:_________________________ 

Your Adress:___________________________________________________________

Your Email:____________________________________________________________  

Please email your questions or order to: danielnie@aol.com

$99 each . Up to 2 names on 1 pendant. $19 per 18" chain

Name(s) on Pendant:____________________________________(print) 

 (view web site and indicate) Shape ___________________________(round /Sq)

Chain (circle one, optional) __________________silver/gold  _________________

Total your cost: Pendant(s): $______________; Chain(s): $________________. 

Special design please add $19: $____________; 

+ Sales Tax (6%)____________; 

Shipping $15.90: $__________. 

Total:$_______________. Paid by credit card________, check_________, cash______. *__________________

Credit card #:_________________________ ; Exp date (mm/yy):____________; V -code:________; 

Billing zip code: ________

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If you have questions, please text the artist at 704-574-1815      Thanks!