Fax Order Form

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Mike's Fine Jewelry Fax Order Form Fax: 1-205-251-0030 (Please complete all sections)

To: Mike's Fine Jewelry	Date:	_____________________________
Fax: 1-205-251-0030	Sender:	_____________________________
	Organization:	_____________________________
	Phone:	_____________________________
Attn: Online Jewelry Sales	Fax:	_____________________________

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Online Order	Info Request	Other
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to place your jewelry order, please provide the following required information:

Your Name:	________________________________________________________
Street Address:	________________________________________________________
City:	________________________________________________________
State/Province:	___________________________________
Zip/Postal Code:	___________________________________
Contact Name: (if different)	___________________________________
Contact Phone:	(_______) __________________________
Email:	________________________________________________________

Payment Method: (Circle One)	Credit Card	Check/Money Order	Wire Transfer	Western Union or Money Gram
A valid telephone number, where you can be contacted, must be provided in order for us to process your order.
Gift Certificate Purchases and Redemptions:
To Purchase a Gift Certificate please provide the following REQUIRED additional information: Gift Certificate Recipient Name:______________________________________________________________ Gift Certificate Recipient VALID Email Address:_________________________________________________ Include Message (up to 120 characters):____________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Gift Certificate Amount: $_____________ (Whole Dollar Amounts Only from $50 - $500) Sender: (other than above)_________________________________________________________________
To Redeem a Gift Certificate please provide the following REQUIRED Information: Your Name:______________________________________________________________________________ Your Email Address:_______________________________________________________________________ Contact Telephone Number:_________________________________________________________________ Redemption Code(s):______________________________________________ To complete your purchase, enter the Item Number of the jewelry you have selected, sign the form and fax to Mike's Fine Jewelry at (205) 251-0030. A valid telephone number must be provided in order for us to process your order. Call us toll free at (800) 290-4478 with questions about your certificates.

Product #	Description	Size	Price Each

Please review your order prior to faxing to insure the accuracy of the information you have provided.

Upon receipt of your completed fax order form, we will contact you at the contact phone number given above to:

Confirm your order;
Answer any questions you may have;
Arrange for payment and free shipment of your order.
Your signature below indicates and acknowledgement that you have read our Merchandise Return Policy and further understand that all special and custom orders sales are non-returnable and FINAL.

Enter Special Instructions, questions or information requests here:
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Your Signature

Enter Our Online Jewelry Store Women's Estate Jewelry Collection \| Men's Estate Jewelry Collection
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CALL US TOLL FREE @ 1-800-290-4478

Mike's Fine Jewelry
2324 1st Ave. North
Birmingham, Alabama 35203
(205) 251-0005 - Phone
(205) 251-0030 - Fax