Please note that these prices include taxes and delivery fees.

All Revenues will go to the Kelly Shires Foundation

First name:_______________________________________

Last Name:_______________________________________

 

Address:_________________________________________

 

Address 2:_______________________________________

 

P.O. Box #:_________________        Apt. #_____________

 

City:______________________         Province:___________

 

Postal Code:______________

Telephone:__________________________________

 

Fax:____________________            e-mail:__________________________

 

I would like to order ______ pin(s) @ $30.00 each. 

I would like to order ______ necklace(s) @$99.00 eacg.

I include a cheque to the amount of  $_____________ addressed to:

EURO JEWELS

907 Boyer Boulevard

Mississauga, Ontario

L5V 1X3