Mail Order Form To:
James A. Hardwick Jewelers
P.O. Box 22903
Salt Lake City, UT  84122-0903
FAX To: 801-575-2106


Name ________________________________________________________

Street ____________________________________________ Unit # ______
         
City _______________________ State ____________ Zip _______-______

Phone _____________________ Email _____________________________
 		NOTE: The prices in our online catalog are for items as shown.  Prices vary according to metals and stones used. Please call or email us for a price quote.

 For price quotes or special requests:
801-661-9016
email Jim at jahardwickjlr@aol.com

To help clarify your preferences you may include pictures, sketches, etc.
 

1. Item #___________Ring Size________ Bracelet/Chain Length________

Price  $_______.____

Metal:  14kt yellow____14kt white____Platinum____Sterling____ Other_________________

Stones: Center/Faceted ______________________________________________________

Inlay_______________________________________________________________________

 		 Additional notes, requests or shipping information:

2. Item #___________Ring Size________ Bracelet/Chain Length________

Price  $_______.____

Metal:  14kt yellow____14kt white____Platinum____Sterling____ Other_________________

Stones: Center/Faceted ______________________________________________________

Inlay_______________________________________________________________________

 		 Additional notes, requests or shipping information:

Payment Method


Subtotal $______.____

Tax (6.85%--UT residents only)  $_______._____

Check Enclosed___Money Order Enclosed___VISA___MC___AMEX___Discover___

Credit Card #_______________________________________Exp________

Name on Card_________________________________________________ 
    Billing Zip Code: ____________  Security Code: ______________
   
Total charged to card:  $__________._____

Signature__________________________________________Date_________
By signing above you agree to pay the total amount due according to the terms of your
credit card agreement.
Shipping
Purchases up to $200 USPS First Class: $5.50
Purchases up to $500 USPS Priority insured: $12.50
Purchases over $500 USPS Registered: $17.50

$______.____


 
  • For your protection we do not store your payment information in our computers.
  • To purchase more than two items attach additional order forms.
  • Your satisfaction is guaranteed.

 

Total Due   $__________.______