Shantique Gallery Ruby Lane Purchase Order #:	* required If you're paying for a Gift Certificate, just enter "Gift Certificate" or "GC" above.
Total Due (as shown on Ruby Lane Purchase Order)	* required If you're purchasing a gift certificate, enter the amount of the gift certificate here.
	BILLING ADDRESS INFORMATION
Title:	None Mr. Mrs. Ms.
First & Last Name of Cardholder:	* required
Bill-to Street Address:	* required
Street Address #2 or Apt/Suite #:
City:	* required
ZIP or Postal Code:	* required
State or Province:	* required
Country:	* required
Phone Number:	* required Your phone number will only be used in case of a stock, delivery, or credit card issue.  We do not rent or sell our customer's contact information.
Alternate Phone #:
Email Address:	* required
Re-enter Your Email:	* required
Is this a business?	No Yes
If Yes, Company Name:
	Before submitting, please check over the information given above for accuracy.  The address supplied above MUST match the one on file with your credit card, otherwise your card will deny the charge. Once you've confirmed the information above is correct, click the "Submit" button.