Mal-In & Fax-In Orders Please print out this order form to order by mail or fax. Fill out the form completely, then send the order form to us:

Order Line – 877-652-2288 Fax Order Line – 985-652-2288 www. Hiosilverjewelry.com 3004 Main Street Laplace, LA 70068

ORDER FORM      - Printable version Item Number Description Size Unit Price Qty Total                                                                                     Shipping Method Price USPS USA - Priority $5.95 - Free on orders over $75 UPS Ground USA - 2 Day Air $8.29 USPS - Express $15.00 UPS USA - Next Day Air $39.13 Sub-Total   Shipping & Handling   Sales Tax LA Residents - 4%   Grand Total

Select Payment Method: Check Money Order MasterCard Visa American Express Discover Card Number Expiration Date (Month / Year)   CID Number last 3 digits on back of MC & Visa - 4 digits on front of AmEx   Signature

Billing Address Name   Address   City   State   Zipcode   Email   Phone   Shipping Address Name   Address   City   State   Zipcode   Email   Phone