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Your Name:
Street Address:
City & State:
Zip:
Country:
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Weekday Phone No.:

Note: Email address and phone number will only be used to clarify orders if necessary.

Qty.	Description	Custom Choices and/or Ring Size	Price Ea.	Total
Merchandise Total
Add Shipping & Handling (*see chart at bottom of page)
NM Residents Add Sales Tax @ 6.3%
TOTAL

Select Payment Method: Check/Money Order Enclosed (made payable to Cruz Studio Jewelry) sorry, no C.O.D. or cash. VISA Mastercard American Express Discover

Name on Card: Card No.: - - - Expiration Date: (month) (year) Signature: ____________________________________