PRINT THIS FORM, FILL OUT AND FAX/MAIL TO
K.C. JEWELRY COMPANY
NAME: ____________________________________________________________
COMPANY: _________________________________________________________
HOME PHONE: ____________________________
WORK PHONE: ____________________________
ADDRESS: _________________________________________________________
APARTMENT or SUITE: ____________________
CITY: __________________________________
STATE: ______
POSTAL CODE: ___________________________
METHOD OF PAYMENT : (please mark your choice)
Money Order: __
VISA: __
MC: __
BANK THAT ISSUED CARD: ___________________________________________
CARD NUMBER : ____________________________________________________
EXPIRATION DATE: __________
CARD HOLDERíS SIGNATURE: _________________________________________
WATCH MAKE: ______________________________________________________
STYLE: ___________________________________________________________
PRICE: ___________________________________________________________
TOTAL FOR MERCHANDISE: $_______
SALES TAX (California residents add 8.25%): $_______
SHIPPING VIA Next Day or 2nd Day: $_______
HANDLING CHARGES: $9.95
GRAND TOTAL: $_______
SPECIAL INSTRUCTIONS / COMMENTS:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
MAIL THIS FORM TO:
K.C. JEWELRY COMPANY
650 South Hill Street, Suite J-2
Los Angeles, CA 90014
OR FAX TO:1-213-629-8061
DISCLAIMER - RADO, MOVADO, and OMEGA WATCHES
K.C. Jewelry is not an authorized dealer of Rado, Movado, and Omega watches.
Thank you for shopping at