FAX:  909-923-9951

Billing Information:

Name:  _______________________________________________________________________________

Address:  _____________________________________________________________________________

City/State/Zip:  _________________________________________________________________________

Phone:  ___________________________________  2nd Phone:  _________________________________

Email Address:  ________________________________________________________________________

Would you like order shipped to a different address?      Yes______     No_______

Shipping Information:  (only if you checked yes)

Name:  _______________________________________________________________________________

Address:  _____________________________________________________________________________

City/State/Zip:  _________________________________________________________________________

Phone:  ___________________________________  2nd Phone:  _________________________________

Credit Card Number__________________________________________________

Exp Date:  ________        3 Digit Code on Back of Card:  _______

(Name and Address on Credit Card MUST match “Billing Information”)

Item Number:  ___________Item Name:________________________________________Price:_________

Item Number:  ___________Item Name:________________________________________Price:_________

Item Number:  ___________Item Name:________________________________________Price:_________

Item Number:  ___________Item Name:________________________________________Price:_________

                                                                                                                    Sub  Total:       $_____________

                                                                                                                    Sales Tax:        $ _____________
                                                                                           (California Residents Only)

                                                                                                         Shipping Charges:       $______________
                                                             (Call or Email your zip code & item number for Amount)                                                                 

                                                                                                                            Total:       $______________

Phone:  626-252-7354
Email:  sales@lmtreasures.com
Mail to:  LM Treasures  
622 N Chalburn Ave.  W.Covina, CA 91790