CUSTOMER MAIL IN ORDER FORM

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     (  )  include gift card:    
  TEXT:      
             
(843) 553-0611          
           
SHIP TO: (if different from ordered by)    ORDERED BY:    
Name: _____________________________________ Name: _________________________________
Address: ___________________________________ Address: _______________________________
City: ______________________________________ City: __________________________________
State/Zip: __________________________________ State/Zip: _______________________________
Phone: (____ )________________ Phone: ( ____ )__________________
      email: __________________________________
METHOD OF PAYMENT:          
Visa MC Discover Check **   Money Order
Credit/Debit Card # _ _ _ _  _ _ _ _  _ _ _ _  _ _ _ _ Signature: ______________________________
Expiration Date:  ____ / _______    CVV2 _________   Date: __________________________________
*Prices subject to change after June 30, 2016.         
Most items are also available in gold. Call for current quote.          
Make checks & M.O.’s payable to Jewelry by Jerome        
** include DL# and State on checks.  Do Not Send Cash!        
           
Rings, Earrings, Pendants
Setting #  - Stone size Stone  Size Description quantity *unit price total
ex. 569-0806 Turquoise 7 8x6mm V shank silver ring 1 11.95 11.95
             
             
             
             
             
             
             
             
             
Chains
Design Length in inches Width/Weight quantity *unit price total
           
           
           
           
           
prices are guaranteed through  Sub-total $    
30-Jun-16
Shipping charges for US destinations, call for overseas charges 8.5% sales (SC residents only)  
If you need returns/exchanges follow directions on packing slip
Mail order to:  JEWELRY by JEROME  ring sizing   10.00   
  15 Sorento Blvd.  S&H $ 3.00  3.00 
  Charleston, SC 29410-8636  TOTAL PAYMENT  $