Midwest Chargers Champ Order Form
2015 Football Champions
Rings take 8-10 Weeks to be made and must be PAID IN FULL
First Name
Your answer
Last Name
Your answer
Billing E-mail address
Please use an email address you use
Your answer
Street Address
Your answer
City
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State
Your answer
Zip Code
Your answer
Cell Number
Your answer
Finger Size
Your answer
Position
5 Characters Max
Your answer
Jersey Number
Your answer
Engraving on Inside of Ring
30 Characters Max including spaces
Your answer
Name on Side of Ring
10 Characters Max
Your answer
Metal Choice
Name on Credit Card
Your answer
Credit Card Number
All card records will be destroyed after processing
Your answer
Credit Card Expiration Date
Your answer
CVV Code
3 digits on the back of the card
Your answer
For Sizing Please Call to Schedule an Appointment
Call 314-961-8875 to book a slot or
Email ashley@jostens1.com
Jostens Cuquets Inc.
9804 Manchester Road
Rock Hill, MO 63119
314-961-8875
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