Jewelry Order Form

Kevin J. McManamon Jeweler
On-line Order Form

by submitting this form and ordering our product(s), you acknowledge that you ARE over 18 years of age
and are legally able to enter into a buyer/sellers agreement.

No I am NOT Yes I AM

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
E-mail
URL

QTY	DESCRIPTION

	BILLING
Credit card
Cardholder name
Card number
Expiration date

	SHIPPING ADDRESS if Other Than Above
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country