Order Form
Please Read Ordering Information Page Before Printing and Filling Out Form
ITEM
BEAD COLOR
(ANY color-no
matter what color
the petals are)
WITH OR
WITHOUT
CAPS
OUR FATHER
BEAD COLOR-
BRACELET
MEASUREMENT
(Must Have When
Ordering Bracelet)
PRICE OF
KEEPSAKE
QUANTITY
TOTAL
PRICE
(All Prices
Include Sales
Tax)
NOTES:
SHIPPING ADDRESS: If shipping of order is needed
TOTAL
SHIPPING
$5
(Only if shipping
of order is required)
TOTAL
ORDER
ROSE PETAL KEEPSAKES
218 Allegro Avenue
Duson, LA 70529
337-315-0421
ORDER DATE: ______________________________________
_____________________________________________________________                       __________________________________________________________
Name                                                                                                                                        Phone

_____________________________________________________________                       __________________________________________________________
Name of Deceased        OR                                                                                                      Date of Birth
AND Date of Death        OR
Name of Person (s) for Occasion (wedding couple, baby, etc.)                                               Date of Occasion (wedding, birth, etc.)

***Please fill out order form completely                                                                                ***Please allow up to 12 weeks for completion of order
***Please submit order form with payment and petals (See Ordering Information Page for instructions on sending petals)
$
$
$
-Specify Bead Color & if
Bead is With or Without
Caps (Needed for
Rosaries, Chaplets, &
Bracelets)
To Print, make sure cursor is not on
table columns.

How did you hear about Rose Petal Keepsakes? ________________________________    Payment Type- Check(#)________  Cash_____
THANK YOU!
Ordering Checklist:

          ___   Place correct amount of roses in paper bag with name written on outside of bag--minimum of 2 roses if possible
    
       ___   Fill out order form:  
Please make sure to:
                  ___ Give full name, date of birth and date of death for deceased -- or names (first and last) of couple
                          for weddings & wedding date.
                   ___Give measurements for bracelets ordered
                   ___Fill all columns (bead color, with or without caps (example shown on products page), Our Father
                          color (if applicable)
                   ___Shipping address if shipping is required   

      ___  Include payment.  Checks or Cash.  Checks can made payable to Rose Petal Keepsakes or Jodi Boudreaux   

      ___ Call to schedule an appointment 337-315-0421 or mail order to 218 Allegro Avenue Duson, LA 70529