Andersen Jewelry Design

8010-A Highway 9

Ben Lomond , CA 95005

(831)336-3525

Fax: (831)336-3005

 

Alan@AndersenJewelry.com

 

Custom designs and special orders priced as negotiated with Alan.

 

 

(all orders shipped to billing address only)

 

Billing Name:           _____________________________________________

                 

Billing Address:        _____________________________________________

           

City, State:            _____________________________________________

           

Zip, Country:           _____________________________________________

           

Billing Phone Number:   _____________________________________________

 

 

Credit Card Type:

Visa ___    Matercard ___     all American Express ___

Diners Club ___   Carte Blanche___  JCB___

 

Card Number:      ___________________________________________________

 

Expiration Date:  ___________________________________________________

 

Print Name:       ____________________________________________________

 

Sign Name:        ____________________________________________________

 

Date:             ____________________________________________________

 

 

California Residents Tax 8.00%                  $_____________

 

Overnight Mail & Insurance add $15.00           $_____________

 

Priority Mail add $4.00                         $_____________

 

Insurance & Handling

($200 or less: $5.00, $201 to $500: $8.00)      $_____________

 

Total                                           $_____________

(Purchaser is responsible for reporting any district use tax.)

 

Use area below for detailed description of purchase