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Please Complete and Print This Form and Fax to 210-930-3903 or Call Toll Free 1-866-333-3715 | ||||||
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Badge # _______________ Rank _________________ Name _____________ |
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Reverse Inscription : $30.00
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Shipping: USPS Ground return receipt ($12.50) OR FedEx Overnight ($25.00) |
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Texas Residents Please Add 8.125% Sales Tax |
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Total Order |
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Payment Method Visa [ ] Master Charge [ ] American Express [ ] | ||||||
Name on card: | ||||||
Signature | ||||||
If the SHIP TO is the same as INVOICE TO Please enter Same | ||||||
Invoice To: | Ship To: | |||||
Name | Name | |||||
Address | Address | |||||
City | City | |||||
State Zip | State Zip | |||||
Contact Information | ||||||
Day Phone Eve phone | ||||||
Ask For | ||||||
Email Address | ||||||
Referred By Or Distributors Name | ||||||
SAdiamonds is owned and operated by Alamo City Gold & Silver | ||||||