Mail Order Application Form


Please provide the following contact information and fill out the form below:

Mail Ordering Information

Payment may be made with:  money order, cashiers check, personal check or travelers check.             

Please allow for shipping cost. Cost may be determined by clicking on the UPS link

 UPS Shipping Cost from National Diamond and Gold

          Make checks payable and mail to

                          National Diamond and Gold

 P.O. Box 561

          Tipp City, Oh 45371

Item Inquiry  

Your Name

Title If Applicable
Organization If Applicable
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone

Cell Phone

 

FAX
E-mail
Card Number

if applicable

 

 

Card Number Again Verify

 

Expiration Date

 

Comments  

 


Copyright 1999 [National Diamond and Gold]. All rights reserved.
Revised: 09/10/04

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(c) Copyright 2003National Diamond and Gold