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Please print this form, then complete it and mail back to:
PROFESSIONAL JEWELER
PO BOX 9001, Maple Shade, NJ 08052 USA
OR

FAX BACK CREDIT CARD ORDERS to 215-545-9629
Payment must accompany orders!


Name                                                                                                                        

Company Name                                                                                                      

Company Address                                                                                                  

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If you prefer to delivery to your home address, please complete the form below.
(NOTE: The store address section above MUST be completed even if your subscription will be delivered to your home address. Your subscription will not be processed without this information.)

Name                                                                                                                        

Address                                                                                                                    

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YES! I want to subscribe to Professional Jeweler.
1.  Please check the one type business that best describes your business:
(01) retail jeweler (one store)
(02) retail jeweler (two or more stores)
(03) department store
(04) discount department store
(20) wholesaler
(30) manufacturer
(40) other (specify)                                                                                                                         


2.  If you are a retail jeweler, how many stores (incl. headquarters) are operated by your company?

                                                                                                                        

3.  If you are a retail jeweler, what is the total annual sales volume of your store address listed above (for this location only):

(A) under $250,000
(B) $250,000 to 499,999
(C) $500,000 to 999,999
(D) $1,000,000 to 2,499,999
(E) $2,500,000 to 4,999,999
(F) $5 million and above

4.  Please let us know how we may contact you regarding your subscription and editorial related information:

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Fax     yes no

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_____ One Year Subscription @ $49.95     _____ Two Years @ $79.95

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Please print this form, then complete it and mail back to:
PROFESSIONAL JEWELER
PO BOX 9001, Maple Shade, NJ 08052 USA
OR

FAX BACK CREDIT CARD ORDERS to 215-545-9629
Payment must accompany orders!