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Crystals & Minerals
Order Form

The co-creator partnership between a person and a crystal or mineral represents an agreement to manifest intentions for healing, prosperity, learning, self- realization, and other forms of Divine growth.

When you enter into stewardship with a being from the crystal/mineral realms, you activate a partnership that serves the highest good for both. We are happy to dowse for a crystal or mineral that is an energetic match with you or someone you wish to gift.

To facilitate this process please complete this order form. We will be in touch by phone or email to tell you about the crystal that has chosen you.

Crystals & Minerals Order Form *Required fields
Your Name* :
Email :
Phone Number* :
Fax Number :
Street Address* :
City* :
State* :
Zip code* :
Name of recipient (if different from above)
Date of Birth of recipient* :
Type of crystal or mineral requested (if known :
Price Range* :
Intentions for work with the crystal/ mineral and any additional information* : (Best Time to Call Me Is)

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Mt. Shasta's Middle Earth The Crystal Room
109 Castle Street, Mt. Shasta, CA 96067
(530) 918-9108 • (888) 918-9108 • Fax: (530) 918-9119
E-mail: crystals@crystalsmtshasta.com

Web Management : DarrowGraphics
©2005 The Crystal Room.
www.crystalsmtshasta.com

HOME | Store Tour | About Us | Shopping Cart | Workshops | Contact | Links

The co-creator partnership between a person and a crystal or mineral represents an agreement to manifest intentions for healing, prosperity, learning, self- realization, and other forms of Divine growth.

When you enter into stewardship with a being from the crystal/mineral realms, you activate a partnership that serves the highest good for both. We are happy to dowse for a crystal or mineral that is an energetic match with you or someone you wish to gift.

To facilitate this process please complete this order form. We will be in touch by phone or email to tell you about the crystal that has chosen you.

Crystals & Minerals Order Form *Required fields

Your Name* :

Email :

Phone Number* :

Fax Number :

Street Address* :

City* :

State* :

Zip code* :

Name of recipient
(if different from above)

Date of Birth of recipient* :

Type of crystal or mineral requested
(if known :

Price Range* :

Intentions for work with the crystal/ mineral and any additional information* :
(Best Time to Call Me Is)

HOME | Store Tour | About Us | On-line Store | Workshops
Contact Us | Links

Mt. Shasta's Middle Earth The Crystal Room
109 Castle Street, Mt. Shasta, CA 96067
(530) 918-9108 • (888) 918-9108 • Fax: (530) 918-9119
E-mail: crystals@crystalsmtshasta.com

Web Management : DarrowGraphics
©2005 The Crystal Room.
www.crystalsmtshasta.com

HOME | Store Tour | About Us | Shopping Cart | Workshops | Contact | Links

The co-creator partnership between a person and a crystal or mineral represents an agreement to manifest intentions for healing, prosperity, learning, self- realization, and other forms of Divine growth.

When you enter into stewardship with a being from the crystal/mineral realms, you activate a partnership that serves the highest good for both. We are happy to dowse for a crystal or mineral that is an energetic match with you or someone you wish to gift.

To facilitate this process please complete this order form. We will be in touch by phone or email to tell you about the crystal that has chosen you.

Crystals & Minerals Order Form *Required fields

Your Name* :

Email :

Phone Number* :

Fax Number :

Street Address* :

City* :

State* :

Zip code* :

Name of recipient (if different from above)

Date of Birth of recipient* :

Type of crystal or mineral requested (if known :

Price Range* :

Intentions for work with the crystal/ mineral and any additional information* : (Best Time to Call Me Is)

HOME | Store Tour | About Us | On-line Store | Workshops Contact Us | Links

Mt. Shasta's Middle Earth The Crystal Room 109 Castle Street, Mt. Shasta, CA 96067 (530) 918-9108 • (888) 918-9108 • Fax: (530) 918-9119 E-mail: crystals@crystalsmtshasta.com Web Management : DarrowGraphics ©2005 The Crystal Room. www.crystalsmtshasta.com

Name of recipient
(if different from above)

Type of crystal or mineral requested
(if known :

Intentions for work with the crystal/ mineral and any additional information* :
(Best Time to Call Me Is)

HOME | Store Tour | About Us | On-line Store | Workshops
Contact Us | Links

Mt. Shasta's Middle Earth The Crystal Room
109 Castle Street, Mt. Shasta, CA 96067
(530) 918-9108 • (888) 918-9108 • Fax: (530) 918-9119
E-mail: crystals@crystalsmtshasta.com

Web Management : DarrowGraphics
©2005 The Crystal Room.
www.crystalsmtshasta.com