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Request for Gem Approval Item(s)
(* are required fields)
 
* Approval Item (at least one) - Please give details - Gem, Ct. Weight, Price 
 
 
BILLING ADDRESS
Approval orders can only be shipped only to credit card billing address.
 
1. Credit card to be placed on file *
 
    Expiration Date *
Card Number *  
CID *  
 
 
Name *
Address *
City * State *
Country * Postal Code *
Phone * Fax
Email *
 
 
2. Special instructions and additional information.
  Please enter any special instructions or additional information.
 
 
 
 
3. Click to place credit card on file.
  Please place my credit card on file - No charges will be billed without my authorization.

Thanks very much, .

 
    

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