ORDER FORM FOR MAIL OR FAX

SOLD TO:

NAME________________________________

ADDRESS_____________________________

CITY_________________________________

PHONE__________________EMAIL_______

SHIP TO (if different):

NAME________________________________

ADDRESS_____________________________

CITY_________________________________

PHONE__________________EMAIL_______

QTY

ITEM#

DESCRIPTION

Gift Wrap?

ITEM
PRICE

TOTAL
AMOUNT

SHIPPING:
(See chart below

SALES TAX: 8.25% for
deliveries in NY

GRAND TOTAL:

METHOD OF PAYMENT
____CREDIT CARD (Circle One):
MC • VISA • Discover • AMEX
Account Number:
_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _

Expiration Date:_______________

Signature:____________________________

____CHECK OR MONEY ORDER ENCLOSED.
Please make payable to: Diamante Jewelers

DELIVERY CHARGES
(Includes Insurance)
Up to $100........$6.00
$100-$500.........$8.00
$500 and up......$12.00


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