Request for Gem Approval Item(s)
Approval Item - Please give details - Gem, Ct. Weight, Price
BILLING ADDRESS
Please place my credit card on file - No charges will be billed without my authorization.
Approval orders can only be shipped to credit card billing address.
1
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Credit card to be placed on file
Master Card
Visa
American Express
Expiration Date
Card Number
01
02
03
04
05
06
07
08
09
10
11
12
09
10
11
12
13
14
CID
Name
Address
City
State
Not Applicable
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
NWT
Nova Scotia
Ontario
P.E.I.
Quebec
Saskatchewan
Yukon
Country
Australia
Canada
England
Finland
France
Germany
Holland
Hong Kong
Iceland
Italy
Japan
Netherlands
New Zealand
Ireland
Scotland
Singapore
Spain
Sweden
Switzerland
Taiwan
United Kingdom
USA
Postal Code
Phone
Fax
Email
2
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Special instructions and additional information.
Please enter any special instructions or additional information.
3
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Click to place credit card on file.
PLEASE NOTE - For your protection credit card information is processed by a secure server. Processing time may take between 30 to 90 seconds.
Thanks very much,
bernie_g@GemsUSA.com
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