SPECIAL INTRODUCTORY OFFER

Request our mail order catalog today and receive a coupon valid for a free pair of earrings with your first order

Please complete this brief survey so that we may better serve the needs of those with jewelry allergies.

Do you suffer from jewelry allergy?   Yes No
Are you unable to wear earrings more than a few  hours because of jewelry irritation?   Yes No
How many years have your ears been pierced?  
Have you had surgery because of torn ear lobes?    Yes No
Has your metal allergy been diagnosed by a physician?    Yes No
Where do you normally purchase jewelry?
Have you made purchases via the internet?    Yes No
Would you purchase jewelry on the internet?   Yes No Maybe
How did you hear about us?
Preference    Pierced Earrings Clip-on Earrings
Gender   Female Male

 Please complete the information below so we can send your first catalog

First Name
Last Name
PO Box/RR # (blank if none)
Street Number
Street Name & Apt #
City
State/Province
Zip/Postal Code
Country
E-mail Address

Please allow 12 to 14 days for the delivery of your catalog

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