Louisiana Residents Add 7% Sales Tax 
 
    Please print out this form.

  Please allow 10 to 14 days for delivery. 

  All items are guaranteed for 60 days. Items must be returned in a reasonable 
  condition, those damaged from misuse will void the warranty. 

   Please print clearly      
  Mark Ring Size Needed Above Each Item Number(s)  

  Item Number(s)_____    ______    ______    ______    ______ 
  
  Name: ________________________________ 
  
  Street Address: _________________________________  Apt. # ______ 
  
  P.O. Box #: ______ 
  
  City: _________________ 
  
  State: _________________ 
  
     Zip Code: _________ 
  
     Country: ________________ 

  Phone #: ____________________ 
  
   E-Mail Address: _____________________________ 

  Amount Enclosed $________ 

   Circle Payment:  Check   Cashier's Check   Money Order 
  
               THANK-YOU FOR YOUR ORDER! 

 Please postal mail this form with Check, Cashier's Check, or Money Order to: 

                                           Joseph L. Baril
                                            114 W. Shackelford Dr. 
                                           Buras, LA 70041 
                                                U.S.A.