Please fill out the form below, and click the SUBMIT button at the bottom of the screen to send me your request. You can fill out the space for an in home viewing of my jewelry catalog as well as placing an order.

Put the item number or numbers of the item or items you want financed in this box.:*
Your Full Name (include any suffix) Sr. Jr. III: *
Addres: *
City: *
State: *
Zip: *
Phone (Cell & Home)
If you have a home phone please provide that number also.:
Email: *
Job Information: Job name, Address, Phone #, City, State, Zip, Manager or supervisors name.:*
Social Security #: *
Drivers License #:
Years & Months on current job: *
Reference 1
Provide Name, Address, City, State & Phone #:
Reference 2
Provide Name, Address, City, State & Phone #:
Reference 3
Provide Name, Address, City, State & Phone # :
Bank or Credit Union Information
Include the Name, Address, City, State, Zip & Phone:
I will contact you within 24 to 48 hours to take your information for financing as well as give you the down payment amount and the monthly payment information. A down payment is required on each individual financed order. I will finance your order up to 36 months.:
Fill in the information for an in home viewing and order placing below. Put the day & time you would like. It has to be after 5 pm monday - friday, Saturday & Sunday 9 am - 5 pm:

(Fields marked with * are required)

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