Ship to _____________________________________________________________________________

Street ______________________________________________________________________________

City ___________________________ State ________ Zip Code _______________________

Email ______________________________________

Mail this Order Form with your shoes/items to be bronzed and payment to:

Southwestmart, Inc./Mr. Chavez 1535B Hawkins Blvd #133 El Paso, TX 79925 1-800-405-1978

If you already paid for this order on our website, indicate the date of your transaction on our website here:___________________

How to fill in this order form:

• 1.Item number is next to each product or if none, write in the name of your keepsake, e.g., statue, baby shoe, pacifier, etc.
• 2. If selecting shoe with mount please specify mount finish.
• 3. Plate engraving is a short 2 lines, generally name and birthdate. No more than 18 characters per line. First two lines free with mounted order.
• 4. Print out this Order Form and mail it along with your payment and baby shoes/keepsakes to be bronzed.
• 5. IF YOU ARE SENDING IN A SPECIAL ITEM FOR A FREE ESTIMATE, ONLY INCLUDE THIS FORM, YOUR ITEM, AND RETURN POSTAGE.
• 6. Special Mounting? Add quoted price.
• 7. Shipping Handling - $16.95 unless quoted differently for special items.
• Check here if this is an item for a free estimate _________ Note: Before you mail in an item for a quote, email us with a description of your item (material, size, weight, condition, etc.) to see if we can give you an email quote first.
• Be sure to visit our online catalog at: bronzedtreasure.com.

Your Special Instructions:

* Zodiac & Birthstone free with engraving, additional ones $5 each; first two lines of engraving is free with any order, otherwise 50 cents per letter after first two lines.

ENGRAVING INFO (for mounted orders only) 18 Characters per line.

line 1:

line 2:

birthstone:

zodiac sign:

line 1:

line 2:

birthstone:

zodiac sign: