Order Form - AICF OnLine -

Order Form

Item
Cost

Qty
Total

2" x 1 1/2" Large Sterling Silver Pin
$58

$

3/4" x 1/2" Small Sterling Silver Pin $27

$

3/4" x 1/2" Sterling Silver Earrings
(available in clip-on or post-backing) $47

$

Shipping and Handling (2-3 days delivery)
$ 3

Total
$

I would like to pay by:

American Express AMEX #:

Exp. Date:

Check Amount sent: $

Name Email

Address

City State ZIP/Postal Code

County/Province Phone

How you heard about the butterfly jewelry?

Please mail checks to:
American-Italian Cancer Foundation
112 East 71st Street, Suite 2B
New York, NY 10021

Item	Cost	Qty	Total
2" x 1 1/2" Large Sterling Silver Pin	$58		$
3/4" x 1/2" Small Sterling Silver Pin	$27		$
3/4" x 1/2" Sterling Silver Earrings (available in clip-on or post-backing)	$47		$
Shipping and Handling (2-3 days delivery)			$ 3
Total			$

I would like to pay by:

American Express	AMEX #:
	Exp. Date:

Check	Amount sent:	$