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Kim Dao Jewelery!

Just print this form, fill it out, then Fax or mail it to:

Kim Dao

288 Monore Ave

Rochester, NY 14607

Fax# (607)-262-3795

Ship to: Name:_____________________________________________________ Address:___________________________________________________ City:________________________________State:____Zip:___________

E-mail Address:______________________________Phone:__________

Billing Address (if different than above):

Name:_____________________________________________________ Address:___________________________________________________ City:________________________________State:____Zip:___________ E-mail Address:______________________________

Phone:__________ Invoice date:_________________Shipping date:_________________

Item# Quantity Description Price Total

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

METHOD OF PAYMENT

_____ Money Order or Certified check

_____ Credit card (Visa, Mastercard, Discover, Amex)

#________________Expiration Date _______

Signature _________________________

Invoice total _______

NY residents add 8.0% sales tax _______

Total ________

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