Mélange Jewelry
Contact Me
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| Designer: Rachelle L'Hommedieu | |||||||||
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Las VegLas Vegas, NV 89178 Email: melangejewelry@gmail.com a, |
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| PO #: ________________________________ Terms: ______________________________________ | |||||||||
| PO #: ________________________________ Terms: ______________________________________ | |||||||||
| Ship Date: _________________________________ Ship Via: _______________________________________ | |||||||||
| Bill to: ________________________________________ | Ship To: | ||||||||
| Street: _______________________________________ | Street: _______________________________________ | ||||||||
| City: ___________________ ST: ______ Zip: _________ | City: ___________________ ST: ______ Zip: _________ | ||||||||
| Tele: ____________________ Fax: _________________ | Tele: ____________________ Fax: _________________ | ||||||||
| Email: ________________________________________ | Email: ________________________________________ | ||||||||
| Credit Card # : ______________________________________ | Expir. __________ | ______ Sign: ___________________________ | |||||||
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| TOTAL: | 0 | $0.00 | $0.00 | ||||||
| Designer: Rachelle L'Hommedieu | |||||||||
