GangstaGold Custom Removable Teeth Mail Order Form

NO CHECKS ALLOWED. Money orders only made payable to GangstaGold.com

Note: This form shows in color but does not PRINT OUT in color

• Style # if applicable:    ____________
  

• Total number teeth top:       ____________
  

• Total number teeth bottom: ____________
  

• Karat and color of gold:____________
  

• Or Sterling Silver: ____________
  

• Color of diamond cuts:         ____________
  

• Extended or curved fangs:   ____________
  

• Date:_____________________________
  

• Customer Name:_____________________
  

• Email Address:______________________
  

• Telephone w/ area code: ______________
  

• Address: __________________________
  

• City:________________State:_________
  

• Zip Code:_____________Country_______
  

• Shipping address and name (if different ):
  

• Name:_____________________________
  

• Mailing Address: _____________________
  

• City:____________________State:______
  

• Zip Code:______________Country_______
  

I understand the custom teeth jeweler, will in most cases, finish a putty molds into a labstone mold and that I may confirm this with GangstaGold before sending in my order. However, I understand that if I have any problems sending in an acceptable putty or a required finished labstone mold and the jeweler is not able to "finish or use" the mold, I have 30 days to make and send a suitable mold to GangstaGold. I understand the final acceptable mold impression is my responsibility and I agree to follow through in the time frames stated above. I understand that if there are any issues with my mold and I do not send an acceptable mold to GangstaGold within 30 days, GangstaGold reserves the right to cancel the order and to not provide any product, service, subsutitute or exchange. Payment will be returned by GangstaGold to sender within 90 business days minus a $50 cancellation service fee plus any applicable shipping fees.  I agree to comply with the times frames explained in the gold teeth policies in regards to my gold teeth mold impression.__________________SIGN & DATE HERE

• 1 mold kit:     $35.00
  

• 2 Mold kits:     $50.00
  

• Total price of teeth:___________
  

• Shipping on teeth: ____________
  

• Final Total:      ____________
  

Payment method: (circle 1) Money Order, Western Union, Money Gram

Make payment to: GangstaGold.com

Mail payment, order form & mold to:

GangstaGold.com

P.O. Box 724, Madison, TN ]

37116-0724

Shipping charges within US are:

Mold kit price includes shipping fee

Regular Sets:   $15/ Priority $20/ Express

Sets w/ stones: $20/ Priority $25/Express

International Shipping: $50 per order

We only accept orders sent via USPS. Do not send orders via UPS or FED EX

TN Residents ONLY: TN sales tax applies

NO REFUND, RETURN, EXCHANGE, SUBSTITUTE OR CANCELLATION ON  CUSTOM TEETH & MOLD KITS

Return to the GangstaGold store now

• Type of stone (circle type desired below)
  

• Round Donut Or Princess Cut Diamond
  

• Round Donut Or Princess Cut Cubic Zirconia
  

• Which top teeth with stones:
  

• Which bottom teeth with stones:
  

Genuine diamond or cz stone sets- fiil out box below

If needed use a seperate piece of paper however please keep it simple

OFFICE USE ONLY.

DO NOT WRITE HERE.

Mold is: good, bad, questionable, thin

Re-do: Yes No

Date order received:

Date completed by jeweler:

Date Shipped to Customer:

USPS Shipping Number:

Fill out payment information in box below

Fill out teeth information in box below

Fill out customer Iinformation in box below

In regards to notice at right: In 99.9% of orders, there are no issues with customer mold impressions. Howewer when they have occurred in the past, customers have left orders for 6 months, 1 year or more with us and we can't allow this. We will work together with ANY customer who may be having issues with their mold impression. The only thing we require is that the customer also assume responsibilty for their mold.

Additional designs, comments, special instructions?: