Seawear® Jewelry order Form Please print this form, fill out, sign, fax/mail in or use the shopping cart form. 100% satisfaction guaranteed or full merchandise refund less shipping. Custom/special orders or rings to size are NOT RETURNABLE. No debit/credit cards or PayPal based outside the USA can be processed. Western Union wire, bank wire or US Currency by Registered Post or FedEx for orders outside the USA. You are responsible for any VAT, Customs, GST or PST that may be imposed outside USA. Shipping to USA Billing Address ONLY. Item number  Style (sail, dive, shells, fish, ring size!, etc) Quantity Price  Tax PA residents only 6.0% sales tax  Shipping ground 3-5 days to most lower 48 U.S. destinations one item $5.95 two items $7.95 three items $9.95 four items $11.95 five items $13.95  * add Express Shipping U.S. - overnight or 2nd day is $27 additional for USA   none or add below express ship 1-2 days add $27.00 express ship 2 days add $20.00 express ship 3 days add $16.00 Canada and International Post add $30.00 Canada and International Fed Ex overseas add $60.00 US   Total Click one Check MasterCard VISA Discover American Express Credit Card Exp Date CVV2 # Four digits on front of American Express, three on back of others Signature Date Mail this form to: Charles Bennett - Seawear Inc. PO Box 2025 Chambersburg, PA 17201-0825 fax it to: 1-888-711-6401 (toll free) * Questions email info@seawear.com

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