Somerset Silver Order Form

Minimum Wholesale Order - $100.00
Minimum Retail Order - $25.00

Company Name:


Ship To Address:

Resale Tax ID#:   City, State, Zip:
Contact:   Phone:
Website/Email:   Fax:
Bead # Quantity Bead# Quantity Bead# Quantity

To ensure your security, please call or fax in your credit card information--do not send it via email:

Method of Payment (circle one):

       Visa           Mastercard


Name on card:                                                  

Account #:                                                                                     

Exp. Date:                          3 digit security code:           


Do you want us to make substitutions if items are out of stock?    Yes   No

How did you hear about us?

We ship most orders within 1-2 days using USPS or UPS


Reload Image (Please enter the code you see to the left)

You can print this form and fax it to us, or click the Submit button to send it via email.


 P.O. Box 253, Mukilteo, WA 98275      Phone: 800-281-1170    Fax: 425-641-3394