Rain Jewelry Order Form
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1Order FOrm
Fax to 781-642-8889
Order Date:
Customer P.O. #
JEWELRY COLLECTION
Bill To Address
Ship To Address (If different from billing address)
Name/Contact
Name/Contact
Company
Company
Address
Address
City/State/Zip
City/State/Zip
Phone
Fax:
Phone
Fax:
Email
Email
Qty.
Item # / Description
Price
Total
Qty.
Item # / Description
Price
Total
ORDER TOTAL
Credit Card Information
Back Order
Yes
No
Merchandise Carded
Yes
No
Substitutions
Yes
No
Requested Ship Date: ______________
Cancel Date: ______________________
expiration
disc
visa
date
Comments:
month
year
zip
#
mc
amex
svc
code
? y
n
can we keep this card info on file
Signature
Tax ID #
332 Second Ave. 2nd Fl Waltham, mA 02451
please copy and fax this form when placing an order
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