SPIRIT SHIELD ORDER FORM

Spirit Shield Order Form

Please fill in the appropriate boxes

Shipping Address
First Name:
Middle Name:
Last Name:
Street:
City:
State:
Country:
Zip Code:
E-Mail:
Phone:

The Spirit Shield is unique and designed especially for you. It would be very helpful to me if you could take the time to answer a few questions about yourself.

When is your birthday? Please include month day year
time (specify a.m. or p.m.) and location of birth
What are your favorite colors?
Do you prefer pastels , bright colors , or more muted, earth tones?

When answering the following animal questions, consider all animals, including birds, reptiles and mammals.

Do you know what your own animal totem is? If so, what is it? There may be more than one, so please list them all.
If not, do you have a favorite animal or have you ever felt strongly attracted or connected to any particular animal(s)? (Please list)
Are there any animals you strongly fear? (Please list)
Have you ever been bitten or attacked by a wild animal? If so, which animal?
Are there any particular symbols that you feel attracted to? (Please list or describe).
If you didn't have a job to go to, would you consider yourself a day person or a night person?
When taking time to be in nature, do you prefer: (check all that may apply) Oceans , Mountains , Lakes , Rivers , Deserts , Forests?
Do you have a special place you go to get away from it all? (Please describe).

If you would like your own face incorporated into the Spirit Shield, please send 2 to 4 photos of yourself. Good, clear images are best, a front and a side view would be helpful.

The price of your Spirit Shield is $500.00.

Please send check or money order payable to:

Lilla Luoma
P.O. Box 244
Valley Ford, CA 94972

Payment plans are available. Do you need to arrange for this? YesNo

Please allow 3-4 weeks for delivery.

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