Lords Fine Jewelry      Freedom Rings
P.O. Box 486, Piedmont, OK 73078  *  405-373-2877  * www.lordsfinejewelry.com  *  lords@fullnet.net

ORDER FORM
Please allow 6 weeks for delivery


STUDENT NAME _________________________________________________________________________
ADDRESS ________________________________________________________________________________
CITY ___________________  ______________ STATE _____________ ZIP __________________________
PHONE (________)________ - ________________

RING CHOICE       His             Hers    (See PRICING SHEET for "Extra Charges")
RING STYLE NAME   (Print Clearly) __________________________________________________________________
FINGER SIZE   __________   (HERS above size 10, Extra Charge;   HIS above size 13, Extra Charge)
METAL CHOICE    (Check One)     Sterling Silver                           10K Yellow Gold
                                                            14K Yellow Gold                      14K White Gold
METAL FINISH     (Check One)      Antique Finish (Black Background)
                                                            Natural Finish (No Black Background)  Natural Finish Not Available With Flags
FULL SCHOOL NAME   (See Pricing Sheet For FREE Options) ______________________________________________
SIDES OF RING   (See pages 12 thru 18 of catalog)
                  
           Side A:     If applicable, print student name, mascot name or graduation year ( Max. of 7 letters),
                             or College Degree (Max of 3 letters). ___________________________________
                             Give Emblem Name & Number: ____________________________________  
                   
            Side B:      If applicable, print student name, mascot name or graduation year (Max. of 7 letters),
                              or College Degree (Max. of 3 letters). ___________________________________
                               Give Emblem Name & Number: ____________________________________

                  Graduation Year  __ __ __ __                   No Year On Ring

This area is for PRESTIGE COLLECTION  only!    School Initial for Top of Stone, max. 2  ___  ___
      Outside Initials, max. 2   ___  ___
      Check One:  With HS                             No HS


SYNTHETIC STONES  See Page 19, Check One:

  Black Onyx (stone color may vary)
  January, Garnet     February, Amethyst      March, Aquamarine         April, White Spinel
   May, Emerald       June, Alexandrite          July, Ruby                           August, Peridot
   September, Fire Blue Spinel                             October, Rose Zircon       November, Topaz 
  December, Blue Zircon

STONE OPTIONS 

     See Page 19, Check One:       Faceted (FREE)    Starburst (Extra Charge)  
                            Check One:        Under Stone Initial (Extra Charge)
                                                                           Block  Script  Old English
                                                        Under Stone Emblem

                             Give Initial or Emblem #: _______________

ENGRAVING (Max. of 15 letters, Extra Charge) ________________________________________________

INSURANCE, STOLEN/LOST (Ring Replacement Insurance, Extra Charge, 4 Year Coverage):  Yes   No

FULL PAYMENT MUST ACCOMPANY ORDER:  (See PRICING SHEET to calculate cost)

             Amount Enclosed: $_________