The Geode Gallery Order Form

Thank you for shopping with The Geode Gallery.  To place an order, please fill out the order form below.  Privacy Policy:  Your information is kept confidential and will never be shared or sold to a third party.  The information is used only to process your order.

NOTE:  To move between Text Boxes, use your <TAB> key or mouse.  Hitting <Enter> will submit the form prematurely in most web browsers!

Your Name/Shipping Address [If paying with credit card, please list your billing address (if requested we will ship to a different address - list in box at bottom)]:

Name First Last
Address Street/PO Box
  City State/Province Zip/Postal Code
Country (if outside USA)
E-mail (please include @ symbol)
Telephone

Preferred Shipping Method

USA Orders:  Post office - Priority (avg 2-3 days)   Post Office - Parcel Post (2-10 days)   FEDEX (Ground) - (1-5 days)   Lowest Price

International Orders:  Post office - Airmail (4-10 days) Post Office - Surface (3-10 weeks)      FEDEX (Express) - (1-4 days)  Lowest Price

Specimens You Wish To Purchase (include additional specimen #'s in comment form below):

Specimen Number: Specimen Number:
Specimen Number: Specimen Number:
Specimen Number: Specimen Number:
Specimen Number: Specimen Number:

What payment method do you intend to use to pay for this order?

Visa     Mastercard    Discover/Novus    American Express    PayPal    Check    Money Order     Western Union
 
If payment method is by credit card (in USA): I will call you  Please call me at # above between and time zone:
We do not ask for your credit card information over the Internet since this is not a securely submitted order form.  If we have your credit card information on file from previous orders, please indicate this in the information box below.

Enter additional order information below (this may include a different shipping address, additional requested specimens, or special order instructions):

Thank you for your order! 

Note:  If you receive an error message or do not get the confirmation page that the order form was submitted, or receive an e-mail or phone call of your order confirmation within 24 hours, please send us an e-mail or call us at (309) 335-6740 with your order information.