Bracken’s Jewelers
- Fax
Order Form -
1-310-821-6052
Thank you for your interest in our beautiful jewelry.
To purchase an item using this Fax Authorization Form:
(1) Simply, print this page.
(2) Complete the information requested below and fax it back to Bracken’s
Jewelers.
(see our "Ordering
Information" page for TERMS AND CONDITIONS)
Direct any questions to your salesperson. Salesperson. : ______________________________
Customer Information
Name:
Tel:
( ____ ) ______________ Fax: ( ____
) ________________
Shipping Address:
__________________________________________________________________________
__________________________________________________________________________
Item Name :__________________________________________________________________________
Size: _______________ Price: ______________________
Shipping Charges & Specifications: ____________________
(see our "Ordering
Information" page for details)
Sales Tax (8.25% CA residents only):__________________
Total Amount to be charged: $ _____________________
Bracken’s Jewelers has my written permission to charge my credit card for
the above
listed merchandise in the above listed total amount.
Credit Card Number:
______________________________________________________
Expiration Date: _________________
Card Type: ______________________________
Credit Card Billing Address:
__________________________________________________________________________
__________________________________________________________________________
Signature:
_______________________________________________________________
Bracken Jewelers Gold Rush Satire Mining to Making Mining History
Natural California Gold Rings One of a Kind Gold and Gem Treasures
Natural California Gold Nuggets
Gifts for All Ages Ordering Information Email Us