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Application Form Name: Address: Telephone No: Description of Jewellery: Weight (grams) Do you want any of the gems contained in the jewellery returned: Yes/No Preferred Payment Method: Cheque or Postal Order (Please circle) Please sign to confirm you declare that the enclosed items belong to you and you have read the declaration below. Signature: Date: Declaration: I declare that the enclosed items belong to me and I acknowledge that I will be paid only for the weight of gold. Any gems will be returned if requested by me in this application. The final amount sent to me for the purchase of the enclosed gold will be up to plus or minus 10% of the weight stated above in which you will be paid immediately by cheque or postal order. Any discrepancies +/- 10% I will contact you before payment is made. Send to: Cash in your Gold PO Box 593 Fareham PO14 9GD