Dari's Jewelry
Order Form
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Yellow Gold:
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Platinum:
14K
18K
Platinum
Item #:
Description:
Size:
Amount:
Birthstones:
................................Birthstones...........................
January..............Garnet.......................$45.00
February.............Amethyst................$45.00
March...............Aquamarine..............$45.00
April................Diamond.....................$125.00
May....................Emerald.....................$85.00
June..............Alexandrite/Pearl......$45.00
July.......................Ruby...........................$85.00
August................Peridot......................$45.00
September............Sapphire..............$85.00
October...Pink Tourmaline/Opal...$45.00
November.............Topaz.....................$45.00
December...........Blue Zircon............$45.00
$:
Engraving:
$1.00 Per Character
Description:
$:
If You are located in California add 8.5% Sales Tax:
$:
UPS Shipping within the USA:
Ground ..............$10
2nd Day.............$20
Next Day...........$30
Outside U.S.A ...$25
$:
TOTAL $:
Name on the Card
Master Card:
Visa:
Credit Card No:
Exp. Date:
E-Mail
SIGNATURE:
______________________________________
Date:
__________
For Your Security and Peace of Mind, Please, Print this Order Form and Mail To:
Dari's Jewelry 101 Utah St. Suite 116, San Francisco CA. 94103
or Fax to:
1-415-621-7218
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