Moissanite Order Form

MoissaniteJewelry.com
Printable or Email Order Form
Use this form to Print, Fax, Mail, or Submit by Email.
Credit Card orders over $900 must also be printed & faxed with signature

Go to Secure on-line form

Order / View items selected in Shopping Cart

Don't worry! All info is reviewed before processing, If there are any incomplete fields, mistakes or discrepancies we will contact you for the additional info we need.

JEWELRY

Quan Item#    Description / Details, Gold Color, Stone Size, etc PRICE

Special instructions or ring sizing (2-5 days).
Standard size 6 - 7 (usually 6)

Platinum sizing, Double 14k price.

LOOSE STONES

   Quantity    Size - Dia size - Shape - Price each PRICE







Choose Shipping (includes insurance)

Florida residents add 7% sales tax

Total Price
Total

BILLING

Credit card

Cardholder name

Card number Special order items are subject to a 15% restocking fee. Returns must be authorized & made within 1 week.
Custom/modified items are NOT returnable.

Expiration date

Signature
(required over $900)
____________________________________

                     Partial Payment amount (if applicable)






SHIPPING INFORMATION

SHIPPING ADDRESS
Physical address for UPS (No PO Boxes) BILLING (if different)

Name

Address

City

State/Province

Zip/Postal code

Country

Phone

E-mail

Additional Comments or Special Instructions

JEWELRY
Quan	Item#	Description / Details, Gold Color, Stone Size, etc	PRICE



		Special instructions or ring sizing (2-5 days). Standard size 6 - 7 (usually 6)	Platinum sizing, Double 14k price.
LOOSE STONES
Quantity		Size - Dia size - Shape - Price each	PRICE



		Choose Shipping (includes insurance)
		Florida residents add 7% sales tax
		Total Price	Total

	BILLING
Credit card
Cardholder name
Card number		Special order items are subject to a 15% restocking fee. Returns must be authorized & made within 1 week. Custom/modified items are NOT returnable.
Expiration date
*Signature* (required over $900)	____________________________________

	Partial Payment amount (if applicable)


SHIPPING INFORMATION
	SHIPPING ADDRESS Physical address for UPS (No PO Boxes)	BILLING (if different)
Name
Address
City
State/Province
Zip/Postal code
Country
Phone
E-mail