GEMS & JEWELRY R US
Jackie Milburn
P.O. Box 344
Boyce, VA 22620
Phone: 1-304-897-5783
Email: jewelry@gemsandjewelryrus.com
ORDER FORM
(To print go to file select print)
first/last name:
street:
city:
state:
Phone#:
zip code:
Date: / /2000
QTY
_____________Description_______________
__Price__
Item_Total
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$
$
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$
$
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$
$
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$
$
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$
$
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$
$
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$
$
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$
$
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$
$
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$
$
sub-total
$
S & H
$
TOTAL
$
Send payment along with this order form For Immediate shipment