ORDER SINGLE ISSUE

PLEASE FILL OUT FORM, PRINT & MAIL TO:
PROFESSIONAL JEWELER
1500 Walnut Street, Suite 1200, Philadelphia, PA 19102 USA
OR
FAX BACK CREDIT CARD ORDERS to 215-545-9629
Payment must accompany orders!

Single copies of Professional Jeweler are $11.00 each, plus $3.00 each shipping. If you would like to order a single copy of an issue, please complete the form below.

Name                                                                                                                        
Company Name                                                                                                      
Company Address                                                                                                  
City                                                                                                                             
State                                                                                                                          
Zip                                                                                                                              
Country                                                                                                                      
Phone                                                                                                                        
Fax                                                                                                                              
E-Mail                                                                                                                         
Web Address                                                                                                            

ISSUE(S) TO BE PURCHASED:
2006
___Jan___Feb___March___Apr___May___June
___July___Aug___Sept___Oct___Nov___Dec
2005
___Jan___Feb___March___Apr___May___June
___July___Aug___Sept___Oct___Nov___Dec

If date is not shown above, please fill in month and year ________________

TOTAL ISSUES ORDERED _____ @ $11 each Plus $3.00 each shipping = $ __________

PAYMENT OPTIONS (payment must accompany order):
____Check enclosed (payable to Professional Jeweler in U.S. funds)
____Visa
____Mastercard
____Amex

Account #                                                                                                                        
Expiration date                                                                                                               

Signature                                                                                  date                               

PLEASE FILL OUT FORM, PRINT & MAIL TO:
PROFESSIONAL JEWELER
1500 Walnut Street, Suite 1200, Philadelphia, PA 19102 USA
OR
FAX BACK CREDIT CARD ORDERS to 215-545-9629
Payment must accompany orders!