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Order Form for John Betts - Fine Minerals

Title

Mr.

Mrs.

Ms.

Dr.

Name *

Email Address * 🛈

🛈

Send an email when minerals are added to this site.

Select customer option: *

New Customer (1st time ordering)

Repeat Customer (new address)

Repeat Customer (use address on file)

Mailing Address (EXACTLY as it should appear on the package.) * 🛈

Domestic U.S. Customers: Your order will be shipped fully insured via US Postal Service First Class or Priority Mail.

International Customers Only:

Declare low value and do not insure. Recipient assumes all risk.

Declare full value and ship fully insured against loss. The recipient is responsible for import duties/taxes.

REQUEST ITEMS BELOW

Just ordering gift certificates, books or magazines?
Use the window at the bottom for Additional Items or Instructions to enter the items you are requesting.

This is not a shopping cart system.

You must provide at least an item number for the items requested.

Item No. 🛈

Description 🛈

Price 🛈

Orders of 4 or more minerals (totaling over $200) qualify for automatic discount (excluding items marked NET).

Repeat customer payment option * 🛈

Use same payment method as my previous order

I will pay with a different method or update my old card

Payment Method * 🛈

PayPal invoices *

Send total in an email. I will use the Send Payment command in PayPal.

Send PayPal invoice.

Credit Card Number (NO SPACES) *

Expiration (mm/yy) *

CVV Security Code * 🛈

Name as it appears on the card *

Card billing address *

Billing address is same as above

Billing address is different

Billing Address (if different than the mailing address above) *

No charge is processed until the day the package is mailed.

Additional items, instructions or comments 🛈

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