If you would like to order via mail, please complete this form.
Otherwise please use our "shopping cart" on this secure site.
His Jewels Creations
3743 Reflections Drive
Pleasanton, CA 94566
Or Fax to:
(925) 417-2275 (please call before sending fax)
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Plus 8.75% sales tax (CA residents only) |
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Notes:
________________________________________________________________________
________________________________________________________________________
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For more items, please print and include a second form.
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Customer Information
*First Name ________________________
*Last Name ________________________
Company ________________________
*Email ________________________
Phone ________________________
Credit Card Information
*Card Type ________________________
*Cardholder’s Name As Shown On Card ___________________________________
*Card Number ______________________
*Expiration Date (mmyy) ____ / ____
*3 Digit Security Code _______________
Check Information
Please make checks payable to
Sheri Cleary
(not to His Jewels Creations)
We reserve the right to ship pending
clearance of personal checks.
*Required fields. |
Billing Address
*Address Line 1 ______________________
*City _______________________________
*State/Province _______________________
*Country _____________________________
*Zip/Postal Code ______________________
Shipping Address (if different from billing address)
Ship To Name __________________________
Address Line 1 __________________________
City __________________________________
State/Province __________________________
Country _______________________________
Zip/Postal Code _________________________
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Thank you for ordering from His Jewels Creations. If you have any questions, please do not hesitate to contact us by phone at: (925) 417-2275, or by email at: HisJewelsCreations@yahoo.com
