Claim Form - Bling Boutique

Please note: Quantities may be limited so it will be a first come, first serve basis.

Name

Address

Phone

Item(s) You Would Like

Select Your Preferred Payment Method

Please Check

I understand that by submitting this form that I will provide the above information to the best of my knowledge. I also understand that I will provide any payment due as stated and if payment is not provided in the timely matter stated that my item(s) may be forfeited. I understand that quantities may be limited so I may not receive the item(s) that I choose