www.motivevotives.com

WE NOW ACCEPT PAYPAL – PAY BY CREDIT CARD EVEN IF YOU DO NOT HAVE A PAYPAL ACCOUNT TO SPEED UP YOUR ORDER! – EMAIL US FOR DETAILS!

*NOTICE: We prefer to be emailed your order request as we can send you designs before you order. If you do not have email, you can use this form (email works best & is quicker because you can see the design in progress). Just fill in the blanks, add the costs, print and mail with payment to:
M.O.M. - 304 Silver Hills Circle SE, Salem, OR 97306 with your check or money order.

Name: Date:
Street Address: Email:
City: State: Zip Code: Phone:

Type in quantity of Glass & extend pricing (start a new order if different wording/colors):
# 23SQVT C 2 x 3" Square Votive
qty:
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# 23RJTB C 2 x 3" Round Jar with Thick Base
qty:
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# 34RJTB C 3 x 4" Round Jar with Thick Base
qty:
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# 23FSWL C 2 x 3" Fountain Square with Lid
qty:
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# 34FSWL C 3 x 4" Fountain Square with Lid
qty:
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# 23SWRL C 2 x 3" Square Jar with Round Lid
qty:
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# 24RWKL C 2 x 4" Round Jar with Knobbed Lid
qty:
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# 35CMOP C 3 x 5" Coffee Mug on Pedestal
qty:
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# 34AJWL C 3 x 4" Apothecary Jar with Lid
qty:
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# 44RJWL C 4 x 4" Rectangle with Lid
qty:
qty x =
Select Wax Color:
Select Word Color:
Please select your Font Style: Caps -BOLD ; Bold Italic ; Normal ; Normal Bold
Select Scent:
Message on FRONT:
Message on BACK:
Special Instructions:
Shipping Charges
Add $5.00 for 1 unit
Add $7.00 for 2 units
Add $8.00 for 3 units
Add $9.00 for 4 units
Add $10.00 for 5 units

On orders of 6 or more units please email us.
Candle Total: $
Shipping Charges: $
Total Enclosed: $



Thank you for choosing motive votives!