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BEADED BELT ORDER FORM
ENTER YOUR CONTACT INFORMATION:
Your contact information is for internal use only; it will not be shared with any entity.
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Name
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First
Last
Email
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
ENTER BIOTHANE BEADED BELT DESCRIPTION:
Belt Size (measurement from end of buckle to middle buckle hole)
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Belt Biothane Color
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Black
Chestnut
Brown
Royal Blue
Other (complete box below) (custom order)
Other Beta Biothane Color (optional)
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Side Strip Color
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Leather - Black
Leather - Light Aqua
Leather - Brown
Leather - Tan
Leather - Dark Brown Leather (matches brown Biothane)
Leather - White
Other leather side strip color (custom order, complete box below)
Other Side Strip Color (optional)
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Bead Color(s), Sizes and/or Descriptions (use info from the website) (NOTES: only 6mm and 8mm beads, rhinestone beads not recommended)
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If you want more than one bead color, describe how you want them arranged (1+1+1 etc., 2+2+2 etc., other. (optional)
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Other Custom Requests (alternate colors, alternate sizes, etc.)
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ENTER OTHER ORDER INFORMATION:
Charity to receive your donation (select one)
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Frederick County 4-H Therapeutic Riding Program (FC4HTRP)
Frederick Health Hurwitz Breast Cancer Fund
Maryland Equine Transition Service (METS) (= Owner-2-Owner)
Catoctin Chapter of PVDA
How will you pay for your belt?
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Via check (made out to Leslie Raulin)
Via PayPal Friends & Family - contact me for instructions
Cash at a show or Blue Horse Farm (I do not have change)
Sorry, but I do not take credit cards (this is not a business) and I must receive payment before I make/mail your brow band.
How do you want to receive your belt?
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Via snail mail (add $8.00 for P&H)
Pick up in Jefferson, MD
Pick up at a show where the brow bands are displayed
YOUR COSTS:
1. Beaded belt materials costs (select one):
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10" beads, stock biothane colors = $30
10" beads, custom biothane colors = $35
20" beads, stock biothane colors = $40
20" beads, custom biothane colors = $45
Enter the amount selected in 1 above.
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2. Enter Your Donation Amount ($35 minimum)
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Donations larger than $30 are appreciated.
3. Postage and Handling (enter $8.00 if belt will be mailed to you) (enter $0 if you will pick up your belt)
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Total Amount You Will Pay (enter total of 1-3)
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1. Complete the information above then click "Submit the Form" below to send your request to me (Leslie Raulin).
2. Provide payment via check, PayPal, or cash (no credit cards as this is not a business):
Check
: Mail a check for the total amount, made out to
Leslie Raulin
, to:
Leslie Raulin
2027 Gapland Road
Jefferson, MD 21755
PayPal
: Send the total amount via PayPal
Friends and Family
(contact me for instructions). Since this is not a commercial endeavor you
must
use PayPal "
Friends and Family
"
Cash
: If you pay at Blue Horse Farm or a show where the belts are displayed. I do not have change.
I will then make your belt and mail it to you or let you know it is available for pick-up in Jefferson, MD.
3. If you want to see / select / design / pick up your belt in Jefferson, MD:
To see/select/design a belt in Jefferson, MD: Email me at
[email protected]
to set up a day/time.
To pick up a belt in Jefferson, MD: I will email you to let you know the belt is ready, then I will place your completed belt in a blue box on the white porch on my house porch - 2027 Gapland Road, Jefferson, MD 21755.
4. If you want to see / select / pick up your belt at a FADS @ Blue Horse Farm or a show where the belts are displayed, just come to the show. Pay via check, cash (I do not have change), or PayPal Friends & Family.
5. I will send a check to the charity for the amount of your donation. I usually send the donations on a quarterly basis.
Your Comments and Requests (optional)
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How did you find out about Brow Bands for Charities?
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THANK YOU!
Submit the Form
Click here
to return to the Brow Bands for Charities website.
