YOU ARE NOT MAKING A PURCHASE BY SUBMITTING THIS FORM.

E-Mail purchase arrangement request

My name is
My e-mail address is

I prefer to pay by Cash Money Order Cheque Credit Card My age is: Over 21 Over 16 Under 16 I prefer to purchase: Prepaid, send by return registered mail Prepaid, send by Bonded Carrier of my choice C.O.D. where applicable, I will pay carriers fees through my legal representative through an independant Gemmologist/Appraiser in person at your office in Vancouver B.C.
	country code,(areacode) number
Please phone me at
I prefer you call during the hours of
But only on these days

E-Mail:Anthony and Patrick

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