ORDER FORM

The Jewelry Factory of  America

2392 W. New Orleans Drive

Broken Arrow, OK  74011

888-495-5070 

Minimum Order is $50

  

*Very Important*

If you leave this page without using the Additional Shopping button below all your information will be lost.  Click on this button to open up a new website window to continue shopping.

Additional Shopping
PLEASE PROVIDE THE FOLLOWING INFORMATION:   (* required)
Contact Name*  
Organization
Street Address*  
Address (cont.)
City*  
State/Province*  
Zip Code*  
Phone
FAX
E-mail
     

BILLING     (Complete if different from Contact information)
Purchase Order # (not required)
Account Name
Street Address
Address (cont.)
City
State/Province
Zip Code

*Credit Card Account Number: *    

Name on card:

Expiration date:     3 digit Security Code

Are you a (choose one)new or existing customer?

Shipping Instructions*:  

Ship to: (if different from billing)

Street Address

Address (cont.)

City

State/Province

Zip Code

 

QTY

     ITEM NUMBER

 ITEM PRICE TOTAL PRICE

    Special Instructions (size, color, etc)

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 

Minimum Order is $50

Be sure you have included your telephone number and/or email to we can confirm your order.

 *Done?  (Type "Yes")                                          Required

 SUBMIT

  

Feel free to call in your order (918)369-5030

 Or Fax your order to (918)369-5031

BWJ Services
Copyright © 2010 The Jewelry Factory of America. All rights reserved.
Revised: 05/14/12