|
Please print, complete and send this order form by fax or mail to: Coyle Wholesale Jewelers, 825 North Providence Rd, Media, PA 19063 USA Fax: 1-610-627-1121 or 1-610-566-9060 (Call before mailing form to reserve item, Toll Free 1-888-635-9555 Local 610-566-8490) |
| Item Description | Stock Number | Price | |
|
Shipping Information: Insurance costs 35 cents per $100 eg. $1000 item times by .0035 = $3.50cents (1000 x .0035) * Note: Some areas are more expensive for overnight shipping. We will contact you if there will be an additional cost to ship to you. FedEx 3 DAY: $8.95 + insurance, FedEx 2 DAY: $14.95 + insurance, FedEx Overnight: $24.95 + insurance, FedEx Ground: $6.00 + insurance US Postal Service: We will contact you. | |||
| *PA Residents Add 6% Sales Tax: | |||
| TOTAL | |||
|
FedEx 3DAY [ ] FedEx 2DAY [ ] FedEx OVERNIGHT [ ] FedEx GROUND [ ] US POSTAL SERVICE [ ] | |||
| Name: | ||||
| Street Address: | ||||
| City: | State: | |||
| Zip/Postal code: | Country: | |||
| Telephone: | E-mail: | |||
| Method of Payment: |
I enclosed a Check [ ] Money order [ ] payable to: Coyle Wholesale Jewelers (or) Please charge my Visa [ ] Mastercard [ ] American Express [ ] Discover [ ] | |||
| Card Number: | Expiry Date: | |||
| * Note: American Express, Visa and Mastercard orders require the "V" verification code on the back of the card. | ||||
| * Amex 4 Digit Code: | * Visa 3 Digit Code: | * Mastercard 3 Digit Code: | ||
| Cardholder Name: | ||||
| Cardholder Signature: | ||||
|
Gift Wrapping Information: (cost $5.00 per item) | Wrap [ ] Don't Wrap [ ] * Please indicate any special gift wrapping information ___________________________________________________ ___________________________________________________ | |||