From Your Personal Jeweler, 37373 100

Qty Item Amount

1. Special Orders may not be returned or canceled and payment cannot be refunded. 2. If purchased, I also accept the terms and conditions of the Ben Bridge Care Plan.

Signature (captured) Captured Signature:_______________

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SPECIAL TERMS

The Special offer of NO finance charge for a 3 month period applies only if the account is kept current. A payment of 1/3 the original charge amount is due each month, and if any payment is missed for any reason, and is not brought current by the 10th of the month following the previous month's billing, finance charges will be applied on the remaining balance according to the terms as specified in our security agreement.