Money Order Order Form

PRINT THIS PAGE OUT AND MAIL WITH PAYMENT **Don't click the submit form button

* Required fields
Name *
E-mail Address *
Phone# *
Address *
City, State, Zip Code *
Shipping Options *
Item # or Description *
Item# or Description
Item# or Description
Subtotal *
Sales Tax 6.75% (no tax outside of NC)
S&H $ *
Total *
US POSTAL MONEY ORDERS ONLY

I have read and agree to the Privacy Policy *

Spam prevention


Please enter the code shown above and click the 'Submit Form' button. This additional step is required to help protect against message spam.

Enter code above:


Don't click the submit form button. Print out form and mail to address below.

Make payable to: Brunson Jewelry

mail payment to: PO Box 4253  WLN, NC 27893

All Sales Are Final. No refunds, exchanges or cancellations on jewelry, measurement kits & custom items.

**NamePlateJewelry.com does not take the molds of a customers teeth for any reason.  We make your custom removable teeth jewelry exactly to the specifications of the molds mailed to us.  For a professional dental teeth mold or impression, please visit your local dentist.