Please print this form and mail with payment to: Blue Sled Ltd. Beads911.com P. O. Box 53392 Cincinnati, OH 45253 Name:_____________________________________________________________________ Address:____________________________________________________________________ City:_____________________________________ State:___________ Zip:_______________ Phone:_________________________________ Email:________________________________ Item                                           description(if applicable)                  Price Each          QTY         Total ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________                                                                                                                             Subtotal_______                                                                                                             6.5% OH Sales Tax_______                                                                                                                         Discounts________                                                                                                                           Shipping________                                                                                                                            Total__________ Payment Type:    Check____ Money Order____ VISA______ MasterCard_____ Name On Card:_______________________________________________________________ Card Number:_______________________________________ Ex Date___________________ Signature__________________________________________ 3 or 4 digit cvv__________ Ship To (If different): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Special Instructions:____________________________________________________________ ___________________________________________________________________________