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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)


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

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©2005 The Crystal Room. 
www.crystalsmtshasta.com