Our Father Bead Caps:  Yes_____ No ______     

Payment Method         

*Check or money order enclosed_______

Make Payable to:  CustomRosaries.com


Gift Certificate______ Certificate #________________________


Visa __  MasterCard__  American Express__  Discover__ 


Name on Card ____________________________


Card Number  _____________________________


Expiration        _____________________________


Signature          _________________________


*checks are subject to a 10 day hold until bank clearance*





















ORDERED BY:


Your Name:________________________________________


Street Address:______________________________________


City / State / Zip:____________________________________


Phone:__(________)_________________________________


E-Mail____________________________________________

Select from online catalog, then specify your choice below.

Full Rosary Hail Mary Beads:

Mail To:   CustomRosaries.com

                  P.O. Box 291

                  Coppell, TX 75019

Fax To:     (877) 844-4916

Crucifix & Center Choice:

Misc/Options ( Full Rosary Bead Caps and/or 14 kt Gold Rosary Parts, or Gold-Filled Full Rosary, Sample Beads, Spacer Beads, Rosary Cases, Premade Rosary):


SHIP TO: (If different than ORDERED BY)


Name:________________________________________


Address:______________________________________


City / State / Zip:________________________________



Our Father Beads:

Call Toll-Free: 1-877-844-4916

8 AM-8 PM, EST, MONDAY-SATURDAY

Please have this completed Order Form in hand when calling.  This is an order only line; for questions, e-mail us.


Note:  Write any special instructions on a separate sheet, and fax or mail with this order form.

CustomRosaries.com

Finest Custom Designs

* Shipping, Handling & Insurance for the

  Virgin Mary Statues varies with size.

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