A & D Keepsakes - Order Form


Our Prices
Bezel (Locket) Type	Price
Coin Edge Bezel Gold Filled or Sterling Silver	$19.95
Coin Edge Bezel 14k Gold	$59.95
Braided Rope Bezel Gold Filled or Sterling Silver	$29.95
Braided Rope Bezel 14k Gold	$149.95
Chain	Add $4.00
Shipping	Add $5.00

Step 1: Pattern

Step 2: Bezel

Step 3: Chain

Light Rope ChainNo Chain

Example:

(all fields required)

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

e-mail:


Name on the Card:
Address Where Bill Comes: (required for card processing)
Zip Where Bill Comes: (required for card processing)
Credit Card Number:
Expiration Date: