e14k.com  -  Secure Order Form

Please provide the following information and make sure everything is correct...
All info is reviewed before processing, If  there are any incomplete fields, mistakes or discrepancies we will contact you for the additional info we need.

	ITEM#	DESCRIPTION	PRICE
		Gold color:     Finger size:
		Gold color:     Finger size:
		Gold color:     Finger size:
		Special instructions
		Shipping (includes insurance)	Other / by Estimate $_____________
		Florida residents add 6% sales tax
		Total Price with Shipping & Sizing	Total

	BILLING
Credit card	VISA MasterCard Discover American Express
Cardholder name
Card number
Expiration date

	SHIPPING ADDRESS	BILLING (if different)
Address
City
State/Province
Zip/Postal code
Country
Phone
E-mail

Additional Comments or Special Instructions