![]() | ![]() |
NAME:__________________________________________________
COMPANY:_______________________________________________
ADDRESS:________________________________________________ _______________________________________________________________________
TELEPHONE:_______________________FAX:___________________
Mastercard/Visa Number:___________________________________
Signature:_________________________Exp.
Date:_____________
*Shipping and handling in the USA and Canada $5.50. All other countries please ask for shipping quote.
* Please do not submit your credit card information over the internet, simply print this page and mail or fax it to The Diamond Institute, Inc.
FAX: (360) 928-9605