Secure Payment form for "jujugems.com" & "2die4jewels.com" Website orders

jujugems presents

www.2die4jewels.com

We are experiencing problems with the server - so if you are UNABLE TO SEND your order kindly email us with your phone number and we will be happy to respond ASAP - we do apologize for any inconvenience!

All information transmitted thru this site is ONLY for the use in Processing your website order - we respect your privacy and will never sell, trade or exchange your personal information with anyone else EVER!

*SECURE ORDER FORM*

Pay me directly for your order ...24 hour shipment on all ORDERS!

accepting Visa/MC/Amex/Check Card/Discover

FOR AUCTIONS and/or WEBSITE

BILL TO:
Full Name:

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Apt:

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Email: (*required for confirmation)

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SHIP TO:

(if same as "BILL TO" leave BLANK)
Full Name:

Company Name: *required
if sending to a Business

Address:

Apt:

City:

State:

Country or Province:

Zip/Postal Code:

Payment Method:

Money Order Check Visa MasterCard Discover Amex Check Card BidPay PayPal Cash Other
*I must have this info down below to process your card ... all transactions are processed thru my credit card terminal and are not transmitted thru the internet for your privacy & security.

Card Type:

Name of Bank as it appears on card:

Card Number:

Expiration Date:

Card Holder (name on card):

*COMPLETE ADDRESS where credit card statement is sent to for verification purposes ONLY:

*ZIP CODE (where credit card statement is sent to for verification purposes ONLY):

($1.00 additional s/h for each extra item)

First Class/Air Mail   $4.95    Worldwide
Priority Mail    $6.95     in the US
Global Priority International Mail   $25.00   Outside the US
Overnight Express Mail    $24.95     in the US
      (includes $100 insurance)
Ring Size(s) NEEDED:

Please enter ITEM numbers and/or AUCTION numbers:

Delivery Confirmation   .75 (US only)

Signature & Delivery Confirmation  $2.50 (US only)

Please add any comments or Instructions you have below as well as COUPONS or Gift Certificates you may have:

Insurance up to $50      $1.95

Insurance up to $100    $2.95

Insurance up to $200    $3.95

      ( $1.00 extra per $100 thereafter )

You will be sent an EMAIL CONFIRMATION with total charged to your card and shipping information within 24 hours.

Gift Wrapping FREE on any order
       over $18.00

Gift Wrap per additional item .50

Now available ... Polishing Cloths for all your Jewelry!

Specially treated Polishing Cloth 1@ $2.00

Specially treated Polishing Cloth 3@ $5.00

Specially treated Polishing Cloth 6@ $9.00

Specially treated Polishing Cloth 12@ $16.00



When successfully sent you will receive a Thank You email confirmation!

This form is being safely sent via our SSL SECURE SERVER using 128 bit encryption for your privacy and security using a Thawte Certificate .... details below.