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Jewelry Kitty 

Purchase Order Form          Dealer: ______________

Name: _________________________                  Date____________

Address: ________________________________________________

City: _______________________ State: ____      Zip: ____________

Phone: _______________________

E-mail: ____________________________  Mailing Instruction at bottom of form

            Name on Card              

        Card Number            

Expiration Date

CVV2 number

 

 

 

 

 

 

 

 

Lifetime Replacement Guarantee on Every Product You Order!

Page

Item #

Description

Size

Quantity

Price

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sub Total

 

 

 

 

 

 

Shipping

 

 

 

 

 

 

Tax

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

Mail with Check or Money Order To:
Jewelry Kitty
c/o Banker Marketing LLC
924 W 17th St Suite 1
Bloomington, Indiana 47404
866-961-0292
Or fax to: 812-334-3990