Custom Design Order (TAX FREE)

Step 1: Print out the order form.

Step2: Fill out the shipping information, design, and pay with money order.

 10k Yellow gold10k White gold14k Yellow gold14k White gold18k Yellow goldSilver
1pc $40 $50 $60 $70 $80 $20
2pc $80 $100 $120 $140 $160 $40
3pc $105 $135 $165 $195 $210 $60
4pc $140 $180 $220 $260 $280 $80
5pc $175 $225 $275 $325 $350 $100
6pc $210 $270 $330 $390 $420 $120
7pc $245 $315 $385 $455 490 $140
8pc $280 $360 $440 $520 $560 $160
9pc $315 $405 $495 $585 $630 $180
10pc $350 $450 $550 $650 $700 $200
print

CUSTOM DESIGN ORDER FORM

Pay to:   14kgoldteeth.com

Shipping address:      PO BOX 3280

                                       Mcdonough, GA 30253

1.Name:  ___________________________        2. Address: ____________________________

3. Phone: (                   )   ________________       4. Email: _______________________________

5.Gold Teeth Design Number:  ___________     6. Special Request _______________________

StepDescirptionQTYTotal
#1 Top or Bottom Molding Kit       $20    
  Top & Bottom Molding Kit       $30    
#2 Gold Teeth (Yellow or White / Carat )    
  10k Yellow Gold       $35/each    
  14k Yellow Gold       $55/each    
  18k Yellow Gold       $70/each    
  10k White Gold      $45/each    
  14k White Gold       $65/each    
  Silver      $20/each    
#3 Vampire Fangs       $15/each    
#4 White Diamond Cut       $10    
#5 S&H (USPS Priority mail)      $20   $20
  Total Amount   $
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