jewelry sample - Jewels By Park Lane

jewelry sample
ORDER FORM
DATE
NAME
TITLE
ADDRESS
CITY STATE ZIP CODE
TELEPHONE NUMBER ( )
SOCIAL SECURITY NUMBER
EMAIL:
Park Lane representatives have the option of purchasing one sample of any regular in-line item at
a 60% discount, one sample of any Three Booking Gift for $30.00, one sample each of any “Hostess
Only” items for the discounted hostess price listed in the catalog. ONLY ONE of each item may be
purchased. No duplicates of the same item may be ordered. To order sample jewelry items, list your
selections in the applicable category. (If additional space is necessary, use a second form.)
CATEGORY #1 - REGULAR IN-LINE JEWELRY (Excludes E! live from the Red Carpet collection jewelry)
ITEM
NUMBER
ITEM NAME
(Please indicate size, length, and color choices as well as pierced or clip preference if applicable.)
RETAIL
PRICE
60%
DISCOUNT
YOUR
SAMPLE
COST
REGULAR IN-LINE JEWELRY SAMPLE TOTAL
$
CATEGORY #2 - THREE BOOKING GIFT ITEMS - $30.00 each
ITEM
NUMBER
ITEM NAME
(Please indicate ring size if applicable.)
YOUR
SAMPLE
COST
THREE BOOKING GIFTS SAMPLE TOTAL
$
Visit us: www.jewelsbyparklane.com

CATEGORY #3 - “HOSTESS ONLY” ITEMS
ITEM
NUMBER
ITEM NAME
(Please indicate size, length, and color choices as well as pierced or clip preference if applicable.)
LISTED
HOSTESS PRICE
(already discounted)
“HOSTESS ONLY” ITEMS SAMPLE TOTAL
$
CATEGORY #1 - TOTAL REGULAR IN-LINE JEWELRY SAMPLE ITEMS $
CATEGORY #2 - TOTAL THREE BOOKING GIFT SAMPLE ITEMS $
CATEGORY #3 - TOTAL “HOSTESS ONLY” SAMPLE ITEMS $
Complete an original and make a copy. Keep a copy for your re-
will be returned as your validated guarantee.
SUBTOTAL $
PLUS_____% SALES TAX $
PLUS INS. & TRANS. $ 6.00
GRAND TOTAL $
Discontinued items may not be returned in exchange for current items. Replacements of SAME ITEMS ONLY are
allowed. No alternate choices will be permitted.
Guarantee: Any kit item, sample item, or promotional item that is found to be defective
charge for the replacement of worn or damaged in-line jewelry items.($12.00 service
charge for watches.)
Send to:
Park Lane
100 East Commerce Drive
Schaumburg, Illinois 60173
Fax: 847-884-7064
THIS SECTION FOR CHARGES ONLY
VISA MASTERCARD
DISCOVER AMEX
AUTHORIZATION NO.
TOTAL AMOUNT CHARGED
CID#
CARD
NO.
CARDHOLDER'S INFORMATION (Must be completely filled in and signed to process credit card)
NAME (print) TEL. ( )
BILLING ADDRESS
ZIP CODE
CARDHOLDER'S SIGNATURE
EXP. DATE
Printed in the U.S.A. ITEM #007