Room 3, Level One
Brisbane Arcade,
160 Queen Street
Brisbane QLD Australia 4000
Tel/Fax +61 7 3221 0771

ORDER NO:
____________________________ (Office Use Only)
* If you are a first time customer, we would appreciate you completing all areas of the customer details section.
Established customers need only fill in your company name and any changes that may have occurred to your customer details.

CUSTOMER DETAILS
Name:
Company Name:
Street Address: P'code
Postal Address: P'code
Email Address:
Telephone: Fax:

ORDER DETAILS
Order Date: Contact Person: Your Reference:
/ /
PLEASE ADVISE US IF YOU WISH TO MAKE "DIRECT DEBIT" YOUR METHOD OF PAYMENT
YES NO
PLEASE NOTE, ALL CATALOGUE PRICES ARE QUOTED USING, I/SI DIAMONDS. IF YOU WISH US TO SUPPLY A DIFFERENT GRADE, PLEASE ADVISE US BY MAKING A NOTE IN THE SPECIFIC REQUEST AREA. THANK YOU.
STYLE
QTY
CARAT
COLOUR
MOUNT ONLY
SEMI MOUNT
COMPLETE
COLOUR STONE CHOICE
Eg. BS001 2 9 Y ________ ________ * Created Ruby
 
STYLE
QTY
CARAT
COLOUR
MOUNT ONLY
SEMI MOUNT
COMPLETE
COLOUR STONE CHOICE
01
02
03
04
05
06
07
08
09
10
 

SPECIFIC REQUESTS
OR to +61 7 3221 0771