-::Youth Empowerment Alliance::-

Name:

Street Address:

City / State / Zip:

Phone &/or Fax Number:

Email:

Quantity

Price

Total

Peace Necklace

$14.95 each

Unity Crystal Bracelet

$14.95 each

Prayer Box Bracelet

$14.95 each

Unity Silver Bracelet

$14.95 each

Peace Keyring

$14.95 each

Love Bracelet

$14.95 each

Hope Bracelet

$14.95 each

World Bracelet

$14.95 each

Please add 7% Tax

Subtotal

Shipping

Shipping charges:
4.95 for 1 item
$7.95 for 2
$9.95 for 3 - 5
$12.95 for 6 or more
* Multiple items must go to the same address.

Grand Total

Donations

Payment Type:

Make check out to:
Youth Empowerment Alliance, Inc.

Mail form to:
Youth Empowerment Alliance, Inc.
235 Central Avenue
St. Petersburg, FL 33701

* be sure to attach check
or money order

Please allow 6 weeks for delivery.

Click here to print this form

Thank you!