Jostens Mail Order Form

PRINT
Name:_________________________________________________

Street:________________________________________________

City/State/Zip:________________________ Phone_____________

e-Mail address: ________________________

SCHOOL NAME: Richland High School - ALUMNI
Male: ______ Female:_______

1 - RING CHOICE
See Ring Numbers A-11:____ A-12_____ A-13_____ A-14_____ A-16_____ P-11_____ P-12_____
Class Year:________     Ring Size:_______
Ring will be worn on which hand? Right:_____ Left:______

2 - METAL CHOICE
White Lustrium:______
10K Yellow Gold:_____ 10K White Gold:______
14K Yellow Gold:_____ 14K White Gold:______
18K Yellow Gold:_____ 18K White Gold:______

3 - METAL FINISH
Antique Finish

4 - RING SIDES
Name, Initials or class year ~ Side 1 (bomb/cloud) - maximum 10 characters: ______________
Name, Initials or class year ~ Side 2 (crest) - maximum 10 characters: ______________
NOTE: A-16 and P12 (ladies) maximum 8 characters

5 - ENGRAVING
On the inside of the band:
Bombers Forever!   Your Name, initials, or other in Script
maximum 32 characters:_________________________

6 - PALM SIDE
Smooth band

7 - SIMULATED STONES
Protected Emblem #:_______ (Jostens will add this)
May - Shamrock Spinel
Stones available:

January (Garnet), February (Amethyst Spinel), March (Aquamarine),
April (White Spinel), May (Shamrock Spinel), June (Alexandrite),
July (Ruby), August (Peridot), September (Fire Blue Spinel),
October (Rose Zircon), November (Topaz), December (Blue Zircon).

CREDIT CARD INFORMATION
Amount: $__________     Exp. Date: ____
Credit Card Number:_________________

PRICE
$________ - Cost of Ring
$       25.00 - "Back Date" Charge
$________ - SUBTOTAL
$________ - 8% tax
$________ - TOTAL
$________ - Amount Paid - $50.00 down payment requested
$________ - BALANCE DUE upon delivery

PRINT FORM, FILL IN BLANKS and SEND TO:
Mark Stevens email mark.stevens@jostens.com
Jostens Tri-Cities
P.O. Box 5748
Kennewick, WA 99336
Phone: (509) 586-1621
FAX: (509) 582-0569