POLICE GOLD ORDER FORM

PART 1

LETTERING AROUND GEMSTONE

Your Local Law Enforcement Agency: e.g., Division/Department, Township

___________________________________________________________________________

New Cap Die Special Order Lettering: ___________________________________________________________________________

[Leave a blank for each space between words. 30 spaces/characters maximum]

One Time Service Charge For New Gemstone Cap Die

One Time Service Charge For New Insignia Cap Die

Add $ 100.00

Add $150.00

PART 2

10K YELLOW GOLD BIRTH-GEM RING

CHOICE OF FACETED GEMSTONE

_______Deep Azure Blue

_______Ruby Red

Birthstone for Month of __________________

$585

NON-FACETED CABOCHON GEMSTONE

_______Black Onyx _______Jade _______Cat’s Eye

$600

PART 3

EMBLEM MOUNTED ON GEMSTONE

___Chief ___Captain ___Lieutenant ___Sergeant ___5___10___15___20 YEARS

$600

PART 4

DIAMOND-ON-GEMSTONE

APACHE STAR DESIGN

Diamond Set in Gold Star Mounted on Gemstone Indicated Below

$635

DESERT FIRE DESIGN

Choice of 3 Diamond Sizes Set in Gold Mounted on Gemstone

1/10 Ct.

$825

1/4 Ct.

$1195

1/3 Ct.

$1470

Indicate Gemstone Choice Below

_____Deep Azure Blue _____Ruby Red _____Black Onyx _____

Birthstone for Month of_____________________

PART 5

DIAMOND SET IN WHITE GOLD

[Without Gemstones]

ROYAL AZTEC DESIGN

Choice of 4 Diamond Sizes Set in Gold Mounting

1/3 Ct.

$1575

1/2 Ct.

CALL

3/4 Ct.

CALL

1 Ct.

CALL

PART 6

INSIGNIA DESIGN IN 10K YELLOW GOLD

Insignia Rings are all GOLD –They do not have Gemstones

$625

PART 7

OPTIONAL FEATURES

ALL RINGS IN 10K YELLOW GOLD UNLESS OTHERWISE SPECIFIED

14K Gold ______Yellow or _____White

Add $100

Please engrave initials ___________ or____________________________________ inside ring band

Up to 24 spaces/characters engraved on Gemstone rings

Only 16 spaces/characters engraved on Insignia rings.

Add $ 20

PART 8 No C.O.D. Orders Accepted: Remittance from Canada, Mexico and other Foreign countries must be made by bank drafts or money orders payable in U.S. Currency. They are obtainable from any leading bank.

For Overseas Orders:

Add $ 50 US

PART 9 Please Allow 4-6 Weeks For Delivery TOTAL ORDER: $

RING SIZE: ___________

Any local jeweler will check your ring size.

Name:__________________________________________________________________________________________

Address:________________________________________________________________________________________

City & State:_____________________________________________________ Zip Code: _______________________

Phone:_________________________ E-Mail:___________________________________________________________

Payment: ( ) Check or ( ) Money Order Enclosed ( ) Credit Card Info Below
 

( ) MasterCard or ( ) Visa: Card Number:_______________________________________________________

Expiration Date [MM/YYYY]:____________________ 3 Digit Code on Back of Card:__________________


T J JEWELRY

857 E. White Mountain Blvd. - Pinetop, AZ 85935

Phone/Fax: 1-800-544-9706 - Website: www.tjjewelry.com

Thank you for your order, we look forward to doing business with you