Cameo Estate Jewelry Atlanta Georgia Order Form

Cameo Estate & Designer Jewelry · 2484 Mt Vernon Road · Dunwoody · GA 30338
Phone: (770) 457-9925	www.cameoestate.com ORDER FORM	FAX: (404) 521-4645

Date
Item Number
Description
Price
Shipping & Insurance
Order Total
Payment Type

Ship To: (For credit card orders, must be the same as billing address)

Name
Address
City	State Zipcode

Daytime Phone
Evening Phone
Email Address

For Credit Card Orders
Card holder name
Card Number Expiration
3 digit code reverse side of card

Flip your card over and look at the signature box. You should see either 16-digit credit card number followed by a special 3-digit code, or the last four digits of your card followed by a 3-digit code Enter the 3 digit code in the box above

Signature: ________________________________________ Date: _____________

Special Instructions: (gift wrap, preferred arrival date, etc)

Please type all entries, print this form and use with all orders. If sending check or money order, complete and enclose with payment. If using credit card, complete and FAX to (404) 521-4645