Order Form

If you would like to order any jewelry from the Jana's Jewels Web site, please make your selection on the order form below and click the Submit button to process your order.

Personal Information
Last Name: First Name:
Street Address:
City: State: ZIP: E-Mail Address:

About Your Order
Select the types of jewelry that you are interested in purchasing:
Necklaces Bracelets Watches

Credit card type: Credit Card number: Expiration date:


Additional Comments
Would you like to recieve our e-mail newsletter with valuable coupons? Yes No

What other types of jewelry, in addition to those shown, would you be interested in purchasing?

Thank you for your order.
Jana's Jewels


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