WFG $100,000 CLUB RING ORDER FORM - World Financial Group

WFG $100,000 CLUB RING ORDER FORM

Please print clearly. Your last name will be engraved on your ring.

Name:

(First)

(Last)

Code #:

Mo/Yr Earned:

Date:

Please allow 5 weeks for delivery after cash flow is confirmed for month earned, not from date of order.

Address:

(no PO Boxes please)

Phone:

E-mail:

Earned:

Purchase:

Upgrade:

(WFG pays for upgrading to the next level of Earner's ring.)

PAYMENT INFORMATION IS NEEDED ONLY IF THE ASSOCIATE IS PURCHASING A SPOUSE RING, REPLACEMENT RING OR A REPAIR.

MasterCard VISA

Discover

Money Order Cashier's Check

Credit Card #:

Name:

(as it appears on card)

Expiration Date:

3 Digital Security Code:

Cardholder's Signature:

Authorization Code:

No personal or company checks are accepted. Make money order/ cashier's check payable to World Financial Group, Inc.

1 Diamond for each $100,000

Base Stone

CEO MD Diamond

Credit Card Orders, fax to: 770-248-3350 Money Order or Cashier's Check Orders, mail to: World Financial Group - ATTN: Accounting Department 11315 Johns Creek Parkway, Johns Creek, GA 30097-1517

FOR WORLD FINANCIAL GROUP USE ONLY

Presentation Date:

World Financial Group P.O. Number:

FOR INTERNAL USE ONLY

WOMEN'S RING

MEN'S RING

Exact Ring Size:

(Smallest men's ring size is 6.)

Men's Ring ? $1,735 (Includes 1st $100,000 diamond) $

Trade-In

WFG Men's Ring ? $735 credit

$

(Ring must be returned with the order form to receive credit.)

Check if applicable:

Men 's CEO MD Promotion ? $2,375

$

1 Diamond for each $100,000 Cash Flow ___ x $45 ea. = $

Base Stone (Addition or Replacement cost)

Blue Sapphire ($100,000 Ring) - $60

$

Ruby ($250,000 Ring) - $60

$

Emerald ($500,000 Ring) - $60

$

Topaz ($750,000 Ring) - $60

$

Amethyst ($1 million Ring) - $60

$

Peridot ($1.5 million Ring) - $60

$

Black Onyx ($2 million Ring) - $60

$

Diamond Encrusted ($3 million Ring) - $865

$

Refurbish - $25

$

Adding Stone to Existing Ring - $30

$

Ring Resize - $50

$

Applicable Sales Tax: AZ, CA, CO, FL, GA, IL, MD, NC, NV, $

NY, OH, OR, TX, UT, VA, WA, WI Shipping & Handling

$ 5.00

TOTAL $

Exact Ring Size:

Women's Ring ? $1,070 (Includes 1st $100,000 diamond) $

Trade-In

WFG Ladies Ring ? $370 credit

$

(Ring must be returned with the order form to receive credit.)

Check if applicable:

Women 's CEO MD Promotion ? $350

$

1 Diamond for each $100,000 Cash Flow ___ x $10 ea. = $

Base Stone (Addition or Replacement cost)

Blue Sapphire ($100,000 Ring) - $60

$

Ruby ($250,000 Ring) - $60

$

Emerald ($500,000 Ring) - $60

$

Topaz ($750,000 Ring) - $60

$

Amethyst ($1 million Ring) - $60

$

Peridot ($1.5 million Ring) - $60

$

Black Onyx ($2 million Ring) - $60

$

Diamond Encrusted ($3 million Ring) - $405

$

Refurbish - $25

$

Adding Stone to Existing Ring - $30

$

Ring Resize - $50

$

Applicable Sales Tax: A Z, CA, CO, FL, GA, IL, MD, NC, NV, $

NY, OH, OR, TX, UT, VA, WA, WI Shipping & Handling

$ 5.00

TOTAL $

GRAND TOTAL $

?2015 World Financial Group, Inc. 0049/7.15

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