Return to Index                       Order Form

Lanka Blue Jewelry ....701 Main Ave....Durango, CO 81301


If you would like to order any of our products online, E-mail this form to us. If you would prefer to order by mail, print this form and send to the address above. To order by phone, call (970) 259-6249

Please provide the following ordering information:

          PENDANTS
QTY      ITEM DESCRIPTION, STONE CHOICE              PRICE
  
EAR RINGS
QTY      ITEM DESCRIPTION, STONE CHOICE              PRICE
   
NECKLACES
QTY      ITEM DESCRIPTION                            PRICE
   
RINGS
QTY      ITEM DESCRIPTION                            PRICE
   
                                                                                      TOTAL

BILLING

We will e-mail you confirmation, availability of your order, shipping date and total before any charges are made to your credit card. If you prefer to pay by check or money order, please indicate below. We will e-mail back to you the amount to make the check and where to send it.

I prefer to pay by check / money order:

Pay Pal   

SHIPPING

Ship to Address
Ship to City
Ship to State/Province
Ship to Zip/Postal Code
Ship to Country

Please provide the following contact information:

Name
P.O. Box
Street Address
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail (Please Include for Confirmation)

Enter your comments or questions in the space provided below:


Lanka Blue
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