THE DIAMOND SPECIALISTS INC. OFFICIAL ORDER FORM

CONTINUE SHOPPING

Due to security issues involved in making purchases online and in light of recent rising fraudulent purchase requests. For your security and protection, we require all orders to be made by fax.

Complete the form below. You may enter all information by typing in the boxes or print and fill in manually.
Sign and fax the completed form to.................... We will charge a 20% deposit to your credit card.

The remaining amount will need to be wire transferred to us from your bank account.
We will call you to complete that transaction. Our payment method is for your security only.

CUSTOMER SHIPPING INFORMATION  (*Indicates required field).

*First name 

*Initial 
*Last name  
*Address 

*City 

*State/Prov.
*Zip/Postal   
*Country 
*Home tel 

E-mail  

YOUR SHOPPING CART CONTENT IS LISTED BELOW CLICK HERE TO CONTINUE SHOPPING

You may delete items not required by checking the 'Remove' boxes then click 'Update' button.

No items in cart

ADDITIONAL ORDER DETAILS REQUIRED WHEN APPLICABLE

Ring size 

Chain length

Special order details 

Payment method

Visa  
Master Card  
American Express  

Your credit card information is not collected and is not sent through the internet. The fields below are for your convenience
only and may be filled in manually after printing this form.

Name on card  
Expiry date 
Credit card number  
CVV2 code 

YOUR AUTHORIZATION

Signed this 

 Day of  ,  2005

Signature 

___________________________________

Print name 

________________________________________