Ref: GBC1283861963
Thank you for your interest in our company. As requested please sign this form and return to us with your jewellery in the clear bag provided. Please also send 2 forms of identification.
Full Name
Full Postal Address
Email Address
Telephone
Mobile
DOB
How did you hear about us?
Please select one payment method only:

Cheque
Same day bank transfer (£25 Bank Charge)

Account Name
Bank Name
Account Number
Sort Code
Approx weight of jewellery
    Approx value of jewellery
On receipt of your jewellery, we will inform you of the exact price we are willing to pay for your jewellery and if accepted by you, we will pay you by your preferred method. If you are not happy with our price, we will gladly return your items by insured Special Delivery.
I hereby certify that:

• I am over 18 years of age.
• All items enclosed are mine to sell and that all items are police safe.
• I agree that all items sent in will be tested by destructive and non destructive testing.
• All gold/silver is subject to verification and payment will be based on the gold/silver fix price on the day of receipt, and the actual weight and fineness as verified by GOLD FACTORY LIMITED.

I have read the Terms & Conditions set by GOLD FACTORY LIMITED and by signing this form I state I agree to them.

Signature:________________________________       Date: September 07, 2010

Have you:
  1. Signed this form ( )
  2. Enclosed 2 forms of identification ( )
  3. Enclosed the jewellery in the clear plastic bag provided ( )
Please ensure the parcel is insured with Royal Mail to the value of your jewellery.

GOLD FACTORY LIMITED:
149 The Broadway, SOUTHALL, Middlesex, UB1 1LP.
TEL: 020 8813 8979