ORDER FORM
AMAZING MEDALLIONS
Each Amazing Medallion is an oval of fine hardwood: 2-1/4" x 1-1/2" and 3/16" thick strung on
 _____black cotton string or
______keychain

Cost : $20./ea.; 6 for $100

Shipping and Handling: $3./ea
Please Print, and Mail Order Form to:
Infinite Branches
515 W. Bethel Road
Bethel, ME 04217

603-466-2265
603-723-5175

info@infinitebranches.com

Designate Engraved Symbol:

____Yin and Yang

____Infinity

____Kaballah

____Reiki Konchi

____Wisdom

____Multiple Infinities

____Multiple Hearts

____Meditation

____Starburst

____Helios

____Plain
Name of Purchaser
Name of Recipient
Shipping to Recipient rather than Purchaser? ____Yes ___No
Shipping Address


Telephone # of Purchaser
Email Address of Purchaser
Specific Wellness Energy:
or energy the recipient most needs at the time? ___Yes
Check Amount Enclosed:
Amount to charge to card:
Visa____or Mastercard___
Card Number
V Code
Signature of cardholder:
Note: Maine residents must add 5% sales tax