Eclectic Etc., Inc. 
www.eebeads.com 
P.O. Box 10 
Willow Grove, PA  19090-0010 
1-888-SHOP-ETC  or  215.658.1711 
Fax: 215.658.1191 

Name: 

Address: 

City, State, Zip: 

Phone: 

Email: 
(You will be sent a confirmation including a copy of your order if you provide your email address)

 Overpayment & Backorder: If you send a money order and overpay, we will send substitutions, not refunds.  Make it easy on yourself...use the net and a shopping cart!  If an item you order is not in, we will substitute or include extra of an item you already ordered. 
Payment:  __Money Order  
__ VISA  __Mastercard  __American Express  __Discover 
Sorry...no checks accepted. 

Name on CC:   

Billing Address for CC:   
  

CC #  -  -  -   
Exp Date:  
Security Code:  
(3- or 4-digit code printed on front (Amex) or back (others) of your credit card) 

Cardholder Signature: 

QTY ITEM # DESCRIPTION COST TOTAL
 
Please add $5.00 if your order is shipping outside the United States 
 Subtotal:__________
 Tax (shipping to PA add 6%)__________
 S&H (add $2.00 if under $20.00)__________
 TOTAL__________
 Thank you for shopping with eebeads.com!