Order Form

ORDER FORM

To place an order, please note the Pattern Name, Item Description, Item #, and Price of the Item(s) that you would like to order. Click on the following link to get to our Price List. When you have completed the Order Form, please print out the form and fax or mail it to Bellevie Company Inc.

You can also place an order without using this form by e-mailing the order information to
bellevie@optonline.net or jks33@aol.com

Fax this Order Form to:
Bellevie Company Inc.
Fax: 973-895-5101

Mail this Order Form to:
Bellevie Company Inc.
1248 Sussex Turnpike
Unit B-10
Randolph, NJ 07869

If you cannot find what you are looking for,
we are always happy to place a Special Order for you...just e-mail us at bellevie@optonline.net or jks33@aol.com

If you have any questions and need to reach us directly, please call 973-895-9300.

Thank you for your Order and your interest in Gmundner Keramik!

Ship to Name:
Address:
City, State, Zip:
Phone Number:
E-Mail Address:

Item Number Pattern Name Quantity Unit Price Total

                                                                                                            Subtotal

Sales Tax
(NJ State Residents Only)

Shipping & Handling
(15% of Subtotal)

TOTAL

Please check one:
My check is attached payable to Bellevie Company Inc. (if order form is mailed)
My Visa Credit Card information follows:
        Name as it appears on the card:
        Visa Card Number:
        Visa Expiration Date:

My Master Card Credit Card information follows:
        Name as it appears on the card:
        Mastercard Number:
        Mastercard Expiration Date:

My American Express Credit Card information follows:
        Name as it appears on the card:
        American Express Number:
        American Express Expiration Date:

Date Last Modified: September 9, 2011