Exp.

Date: 12/31/2011 Print Date: 11/7/2011

YOUR RING ORDER SUMMARY

Conf: # 10984355-42623 Grad Year: 12 Email: bdiaz2424@hotmail.com Phone: 3085390916

Name: Billy Jo Diaz Address: 416 South Willow

North Platte, NE 69101

Size

1 2

Ring Choice

Pacifica (T12) - Women's

Stone Color / Icon 1 (L45)

School: North Platte High School Customer #: 04919300 Accent Stone(s) $ Add On

Stone Option/Cut

June Alexandrite
2nd Stone Color / Icon 2 (L45) Ring Side 1

Facet Sunburst
DuraColor Raised Name Other / Stone Band (A39/A40/T31/T32)

Number

Position

School Mascot
Ring Side 2

2012
Raised Name Number Position

Diamond Yeardate Diamond Yeardate

$ Add On

$ Add On

Music TRTF3 4 5
Metal Choice

CLASS OF
Metal Finish Palm Side

White Lustrium
Inside Engraving

Antique (traditional)
Initial(s)

Smooth Band (traditional)

Special Instructions (office use only)

Billy Jo Jamey Diaz

PC Crest Initials PRICING $
Ask about payment options available

OFFICE USE ONLY (shaded areas)

US $147.99

JPP

CUS

SQT
Check Number

Added Product: _____ _____ _____ _____ _____ _____ _____ _____ _____ Express | HANDLING SUBTOTAL ADD TAX ___ ___ ___ ___ TOTAL AMOUNT PAID BALANCE DUE

_____ _____ Ring Protection Plan STANDARD PLAN - 4 YEARS (INCLUDED) Jostens accepts | Visa, MasterCard, | Discover and | American

US $5.99

Circle One:

Paid in Full

Jostens J-Pay

Deposit Only

Credit Card Amount $ ___ ___ ___ . ___ ___ Number: ___ ___ ___ ___

Exp. Date: ___ ___ / ___ ___ ___ ___ ___ ___

___ ___ ___ ___

Signature: ______________________________________________________________
This is a customized product. Cardholder understands payment(s) may be charged before products are delivered. Please allow 6 - 8 weeks for delivery.

............................................................................................
CONSUMER RECEIPT Name:

Billy Jo Diaz

Confirmation Number:

10984355-42623

Sales Rep Name:.Rod And Reid Brakke School

Phone:402-733-0300

Email:reid.brakke@jostens.com

Pacifica (T12) - Women's, Metal Choice=White Lustrium Metal Finish=Antique (traditional) Stone Color=June Alexandrite Stone Options=Facet Sunburst Ring Side 1=School Mascot:2012 Ring Side 2=Music TRTF3:CLASS OF Inside Engraving=Full Name:Billy Jo Jamey Diaz Palm Side=Smooth Band (traditional) Graduation Yeardate=2012 Ring Size=Unknown Ring Protection Plan=Standard Plan - 4 years (included)

Select One: Paid in Full Jostens J-Pay? Deposit Only

_____ Accent Stones _____ S1 Grad YR Dia _____ S2 Grad YR Dia _____ P.C. Crest

TOTAL AMOUNT PAID BALANCE DUE

You may cancel this order within 3 business days from its placement without charge; thereafter cancellations will be subject to a $75 cancellation fee. You may change this order within 7 business days from its placement for no additional charge and within 8 to 14 business days for a $25 charge. No changes are allowed after 14 business days from placement of this order. NOTE: Shipping charges may be added at time of order.
Order is subject to audit. Computational errors will be corrected on invoice. Orders are subject to acceptance by Jostens.

1 Pacifica (T12) - Women's