This form is intended to be filled out on your computer,

 printed out, signed, and mailed or faxed in 

Jewellery Order Form

Choose the necklace you'd like to order, bearing in mind that every fossil and every necklace is unique and may be slightly different in colour than the one you choose. We'll do our very best to match your request

  of sample #1 of sample #2  of sample #3  of sample #4   of sample#5   

  of sample #6 of sample #7  

  

  Total cost including shipping and taxes:     

                These necklaces have been made in Kilifi,  Kenya by Hamisi Mwondoro and other members of his tribe.

 The money they receive from your purchase is helping to pull a small village out of poverty.

Thank you! Together we can make a difference!

 

 Shipping Name:
                       Shipping Address:
                               Shipping City: 

            Shipping Province/State:
                       Shipping Country:
           Shipping Postal/zip code:
  Phone:      Fax:     E-mail:

Check here if your billing address is the same as your shipping address:  or  Please provide your billing details:

                           Billing Name:
                      Billing Address:
                              Billing City:
             Billing Province/State:
                        Billing Country:
            Billing Postal/zip code:
Phone:     Fax: E-mail:


  Payment information:  Cheque or money order  (please make payable to Northern Magic Adventures)           

Visa                     American Express      

Credit card number     Expiry Date (mm/yy):             

                Cardholder name     Signature_________________________ 

 Please fill this form out, print and sign, enclosing your cheque if necessary, and mail to:

Northern Magic Adventures

565 Brookridge Cr. Ottawa, Ontario K4A 1Z3 Canada

or fax to: (613) 841-1879 

Or place your telephone order at: (613) 841-1879

Thank you!