Secure form for Credit Card transfer

CREDIT CARD INFORMATION - SECURE TRANSMISSION You may use the form below to transmit your credit card information in a secure and encrypted format to facilitate your current order and all future orders. Once your credit card information is on file all future orders can filled expeditiously.

Use your mouse or Tab Key to access and fill-in all appropriate fields. You can leave "fields" or "check boxes" blank if they are not applicable.
If you leave the order form page before you've finished entering all your information and submitting it, use your browser's [BACK] button to return to this page to continue where you left off.
When you have completed all appropriate fields, click on the [SUBMIT NOW] button at the bottom of this page to send your information securely to Steve Perry Gems.
You will be notified that your credit card information was received.

The following credit cards are accepted at
Steve Perry Gems:

Visa, Master Card, American Express, Discover & the JCB card

If you want to mail your credit card information to Steve Perry Gems please send it to:

Steve Perry Gems
P.O. Box 136
Davis, California
95616 USA

You can also call your credit card information in at: (530) 753-7861

If you prefer to provide your credit card information here a secure server will process this this form
For American Express and Discover cards please check the JCB box and please note the card type in the special instructions below, thank-you!

Card Type: VisaMasterCardJCB

Card Number: Expiration Date:

Name on the Card: (Name as it appears on the card)

Customer Information:

Please fill out this form also - Your gemstones can not be sent to you unless I know where you live!
Please double check your email address. This is a place where mistakes are commonly made.
*= Required Field.

*First Name: Initial: *Last:

*Address:

*Address:

*City: *State: *Zip:

*Country:

*Home Phone: Work Phone:

*Email Address:

Special Instructions:

Any comments or special instructions should be noted here.
For example: Send specimens to alternative address such as: work address. Or, send via UPS instead of US Postal Service.

Submit this Information:
Please check for typos and omissions -

- Click this button to submit your Credit Card information.

Thank You!!

Card Type:	VisaMasterCardJCB
Card Number:		Expiration Date:
Name on the Card:		(Name as it appears on the card)

*First Name:	Initial:	*Last:
*Address:
*Address:
*City:	*State:	*Zip:
*Country:
*Home Phone:		Work Phone:
*Email Address: