SPECIAL ORDER REQUEST

TO: _______________________

FROM: Leo Hamel Fine Jewelers
__________________________
__________________________

1851 San Diego Avenue, Suite 130
San Diego, CA 92110
(619) 299-1500 Phone
(619) 299-1595 Fax

PO # __________
INVENTORY USE ONLY

Your Name: ______________________ Date: ____________________

Customer Name: __________________________________________________________

DEPOSIT MUST BE ON FILE UNDER THIS NAME, OR THE ORDER WILL NOT BE PLACED!

MEMO  □    ASSET  □

SKU: ____________________________
Size: __________________________
Description: _______________________________________________ Cost: __________________________

SKU: ____________________________
Size: __________________________
Description: _______________________________________________ Cost: __________________________

SKU: ____________________________
Size: __________________________
Description: _______________________________________________ Cost: __________________________

Shipping Method:

• Overnight □
• Second Day □
• Saturday □
• Ground □

Special Instructions: ________________________________________________________
____________________________________________________________________________________

INVENTORY USE ONLY

Ordered by: ____________________________

Date: __________________________

Method: Fax □    E-mail □    Phone □

Time: __________________________

Notes: ________________________________________________________________________________
________________________________________________________________________________

Please note any confirmation number given, name of person e-mailed/spoken to, etc.