MONOGRAM GEMS – ORDER FORM
Please print out, fill in and fax to: 619-696-0596

Step 1:
Last Name (for Family Crest order): ____________________________________________________
Is there an alternate spelling? ___________________________________
___I am providing an image of my family crest.
___Please provide my family crest from your sources. See Notice*.

Initials or Name (for Monogram or Name order): __________________________________________

Lettering Style:  Olde English  -  Old German  -  Plain Block   -  Fancy Script  -  Curly Script  -  Gothic

Step 2:
Gemstone to engrave: Black Onyx    -   Lapis   -   Carnelian   -    Quartz Crystal   -   Tiger-Eye
   (circle one)                 Turquoise**    -   Malachite   -   Bloodstone**
If you are ordering jewelry, go to Step 3, if not, continue to Step 4
Step 3:
Jewelry Style:
Ring       Style:  Florence - Geneve - Hannover
Pendant  Style:  Antwerp - Warsaw
Step 4:

Today's Date:

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Order Subtotal:

$

Name:

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CA Tax 7.75%:

$  

Address:

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Shipping:

$         13.00

City/State/Zip:

-

            Grand Total:

$

Method of Payment: [    ] Check    [     ] Visa    [    ] Mastercard     [    ] American Express

Card Number:

-

Expiration Date:

         /

Cardholder's Signature:

Daytime phone or e-mail if we have questions on your order:

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*Notice Regarding Family Crests:
The reputable source we use to research family crests is J.-B. Rietstap's "Armorial General",  published c.1800. He lists approx. 100,000 European names. For some names there may be several variations of crest design. We will choose the one our source lists.
** call for availability

***If you have special instructions or artwork, please attach a second page***
Please allow 3 weeks for delivery.
Due to the custom nature of these items, all sales are final

Monogram Gems
861 6th Ave #608
San Diego, CA 92101
(619)696-0596