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.)
Zip/Postal Code
Work Phone
Home Phone

Cell Phone


Card Number

if applicable



Card Number Again Verify


Expiration Date




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

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(c) Copyright 2003National Diamond and Gold