Shipping Address
Please fill in the name and address to whom and where your order will be shipped. Information in bold type
in this section is required.
Name: ___________________________________
Street Address: ____________________________
____________________________
City: ____________ State: ___ Zip Code: ________
Telephone Number: (____)_____-_________
E-mail: ___________________________________
Billing Address
If the billing address is different from the shipping address, please fill out the billing address so that I can
send you your invoice. If the address is the same, leave this section blank, and I will put your invoice inside the
box. Information in bold type is required.
Name: __________________________________
Street Address: ___________________________
___________________________
City: _____________ State: ___ Zip Code:
_________
Telephone Number: (____)_____-_________
e-mail: _______________________________
Items to be Ordered
In the tables below, please fill in the information on the item(s) that you wish to order. If you do not want a particular
quality for an item, please write "None" in the appropriate box. For all listed items that you do not want to order,
please be sure to leave them blank.
*Note - "X" in a block means that that colum is not
a choice for that particular item.
*Note for gel candles: A few candles have choices of color or embeds. For those items, fill in the table
as desired, and check the appropriate blank of your choice in the section under the table.
*Note for painted wax candles - fill in the table for the scent and candle color. Next,
fill in the informatino for the painted part of the candle, in the section underneath the table.
*Note for buying more than one of a particular item - If you are buying more than 1 of a particular
candle, and want the same qualities in each candle, just fill out the table, and put down the appropriate quantity
number. If you want different qualities for each candle.please specify this in the Comments and Special
Instructions section on this form.
