Name :
Street address:
City:
State:
Country:
Your e-mail address:
Shipping address (If different)
Payment method:
There are several ways this works. You can use a credit card or you can send me a money order through the post office. If using a money order, I will reply in your e-receipt with the address for you to send it to.
Please specify which you would like to do:
Money order Credit card
*All information gathered will remain confidential and will be kept in our personal files for business reasons.
Please enter you card information below. If you would like to submit another way, you can check the box below and submit your order. I will then respond in email after your order is processed with a link to my paypal account added in with your e-receipt and you can then enter credit information over a secure conncetion using pay pal.. Please note, you will have to have a pay pal account to transfer any funds into mine this way.
You can sign up for paypal here.
Would you like the alternate payment method?
Yes No
If you answered yes to the above, skip the below. Credit card information
Type of card: Check one:
Visa Mastercard
Credit card holder
(Name as appears on card)
:
Credit card number:
Expiration date on card:
Address of cardholder:
Zip code:
Product information field 1:
Item title:
Item Number:
Item description:
Quantity:
Please note: All sizes of jewelry are prespecified by item and are not available in any other sizes. Please make sure you have chosen the right size before submitting your order. Remember, one can always have a ring sized at a jewelers.
Product information field 2:
Product information field 4:
Product information field 5:
Product information field 6:
Product information field 7:
Product information field 8:
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