Order

D&J accepts Check, Money Order, or Credit Cards for payment.

Name(Required)

First Last

Company

Email(Required)

Phone

Fax

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gem 1 Number

Gem 1 Name

Gem 1 Quantity

Gem 2 Number

Gem 2 Name

Gem 2 Quantity

Gem 3 Number

Gem 3 Name

Gem 3 Quantity

Gem 4 Number

Gem 4 Name

Gem 4 Quantity

Gem 5 Number

Gem 5 Name

Gem 5 Quantity

Name

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