Print and fill out the form below, and mail it along with your photograph (packaged between cardboard to prevent bending) to:

Carina
Attention: Photo Charm Orders
87 Rockaway Avenue
San Francisco, CA 94127 USA


Charm Size and Style (enter desired quantity)

___ Style 1 - $38.00  (Medium Size Portrait - 9 mm.)
___ Style 2 - $38.00  (Medium Size Landscape - 9 mm.)
___ Style 3 - $42.00  (Big Size Portrait - 13 mm.)
___ Style 4 - $42.00  (Big Size Landscape - 13 mm.)

Please return my original photograph when you ship the charm.  Yes __  No __

Customer Information 

First Name ___________________________________ 
Last Name ____________________________________
Email Address ________________________________
Daytime Phone ________________________________

Customer Billing Address 

Address _________________________________
Address 2 _______________________________
City ____________________________________
State ___________________________________ 
ZIP _____________________________________
Country _________________________________

Recipient Information (if shipped to person different from above)

First Name ___________________________________
Last Name ____________________________________
Recipient Phone (FedEx only) _________________  

Shipping Address (if different from Billing Address)

Address _________________________________
Address 2 _______________________________
City ____________________________________
State   _________________________________
ZIP _____________________________________
Country _________________________________


Shipping Method 

___ Economy Shipping - First Class Mail (included in price)
___ USPS 3-Day Priority Mail (add $5.50)
___ 2-Day Federal Express (add $14.00)
___ Overnight Federal Express Service (weekday delivery) (add $20.00)  

Gift Note (if a gift being shipped to receipient):

 ____________________________________
 ____________________________________
 ____________________________________


Credit Card Information: (We accept the following cards: VISA MC DISCOVER AMEX)
        
Credit Card Number _______________________________  
Expiration Date __________________________________
CID* ____________________________________

* VISA, MC & Discover: last 3 digits on back of card in signature block. AMEX: 4 digits on front of card just above credit card number.