CHARM / CRESCENT /
BEN MOSS

e-order area

Use this order form as an alternative to faxing and/or emailing.

Select Company:*
- Charm Diamond Centres
- Crescent Gold & Diamonds
- Ben Moss
ORDER #*
Enter your 9-digit number. ex: 123-456789
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ORDER #*
Enter your 8-digit number. ex: 123-45678
Select Store #*
Select Store #*
Select Store #*
Charm STORE Email address*
(replace ### with your store#)
Crescent STORE Email address*
(replace ### with your store#)
Ben Moss STORE Email address*
(replace ### with your store#)
Choose the CATEGORY you are ordering from:*
- Stainless Steel Bracelets
- Leather Bracelets
- Necklaces
- Lobster Charms
- Macrame Bracelets
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Choose Your BRACELET STYLE prod*
(bracelet WIDTH and TAG options to follow)
- CURB Style - Stainless Steel
- CURB Style - Yellow Gold Plated
- FIGARO Style - Stainless Steel
- FIGARO Style - Yellow Gold Plated
- LINK Style - Stainless Steel
- LINK Style - Yellow Gold Plated
- LINK Style - Rose Gold Plated
- NO BRACELET REQUIRED
Choose Your BRACELET STYLE*
(bracelet WIDTH and TAG options to follow)
- CURB Style - Stainless Steel
- CURB Style - Yellow Gold Plated
- FIGARO Style - Stainless Steel
- FIGARO Style - Yellow Gold Plated
- LINK Style - Stainless Steel
- LINK Style - Yellow Gold Plated
- LINK Style - Rose Gold Plated
- NO BRACELET REQUIRED
Choose Your Stainless Steel CURB BRACELET WIDTH*
(TAG options to follow)
- BRAC-CS5 - 5mm Curb (small) - 1179840 - $20
- BRAC-CS - 7mm Curb (medium) - 1131743 - $25
- BRAC-CS9 - 9mm Curb (large) - 1179841 - $30
Choose Your Yellow Gold CURB BRACELET WIDTH*
(TAG options to follow)
- BRAC-CG5 - 5mm Curb YG (small) - 1179847 - $25
- BRAC-CG - 7mm Curb YG (medium) - 1131742 - $30
- BRAC-CG9 - 9mm Curb YG (large) - 1179848 - $35
Choose Your Stainless Steel FIGARO BRACELET WIDTH*
(TAG options to follow)
- BRAC-FS5 - 5mm Figaro (small) - 1179842 - $20
- BRAC-FS - 7mm Figaro (medium) - 1131745 - $25
- BRAC-FS9 - 9mm Figaro (large) - 1179843 - $30
Choose Your Yellow Gold FIGARO BRACELET WIDTH*
(TAG options to follow)
- BRAC-FG5 - 5mm Figaro YG (small) - 1179849 - $25
- BRAC-FG - 7mm Figaro YG (medium) - 1131744 - $30
- BRAC-FG9 - 9mm Figaro YG (large) - 1179850 - $35
Choose Your Stainless Steel LINK BRACELET WIDTH*
(TAG options to follow)
- BRAC-SS - 5mm Link (small) - 1131748 - $20
- BRAC-LS - 8mm Link (large) - 1131746 - $25
Choose Your Yellow Gold LINK BRACELET WIDTH*
(TAG options to follow)
- BRAC-SG - 5mm Link YG (small) - 1179851 - $25
- BRAC-LG - 8mm Link YG (large) - 1179852 - $30
Choose Your Rose Gold LINK BRACELET WIDTH:*
(TAG options to follow)
- BRAC-SR -5mm Link SR (small) - 1179853 - $25
- BRAC-LR -8mm Link LR (large) - 1179854 - $30
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Choose Your Rose Gold LINK BRACELET WIDTH*
(TAG options to follow)
- Mark
- BRAC-LR - 8mm Link LR (large) - 1179854 - $30
5mm Curb in Stainless Steel
7mm Curb Stainless Steel
9mm Curb Stainless Steel
5mm Curb in Yellow Gold Plated Stainless Steel
7mm Curb in Yellow Gold Plated Stainless Steel
9mm Curb in Yellow Gold Plated Stainless Steel
5mm Figaro in Stainless Steel
7mm Figaro in Stainless Steel
9mm Figaro in Stainless Steel
5mm Figaro in Yellow Gold Plated Stainless Steel
7mm Figaro in Yellow Gold Plated Stainless Steel
9mm Figaro in Yellow Gold Plated Stainless Steel
5mm Link in Stainless Steel
8mm Link in Stainless Steel
5mm Link in Yellow Gold Plated Stainless Steel
8mm Link in Yellow Gold Plated Stainless Steel
5mm Link in Rose Gold Plated Stainless Steel
8mm Link in Rose Gold Plated Stainless Steel
Choose Your LEATHER BRACELET Style*
(colour selection follows)
- BRAC-1LE (SINGLE wrap) - 1138466 - $15
- BRAC-1LE-D (DOUBLE wrap) - 1148419 - $20
- BRAC-1LE-T (TRIPLE wrap) - 1148420 - $25
- BRAC-FLE (SINGLE wrap) - 1138468 - $25
- BRAC-FLE-D (DOUBLE wrap) - 1148421 - $30
- BRAC-FLE-T (TRIPLE wrap) - 1148422 - $35
Choose LEATHER COLOUR (plain):*
- Black
- Brown
- Red
- Pink
- Purple
- Blue
- Aqua
- White
Choose LEATHER COLOUR (braided):*
- Black
- Brown
- Beige
Choose MACRAMÉ COLOUR*
- Black (Men's Size 7.5 - 9.5 inches) - 1131747 - $20
- Blue (Kid's Size 5.5-7.5 inches) - 1131747 - $20
- Pink (Kid's Size 5.5-7.5 inches) - 1131747 - $20
- Rainbow (Kid's Size 5.5-7.5 inches) - 1131747 - $20
Choose Your TAG (Leather / Macrame)*
- TAG-RED1 - 1131738 - $39
- TAG-RED2 - 1131739 - $39
- TAG-SEM1 - 1179802 - $44
- TAG-SEM2 - 1179804 - $44
- TAG-BLK1 - 1131729 - $39
- TAG-BLK2 - 1131730 - $39
- TAG-WHT1 - 1179805 - $39
- TAG-WHT2 - 1179806 - $39
- TAG-BLU1 - 1131731 - $39
- TAG-BLU2 - 1131732 - $39
- TAG-AQA1 - 1179807 - $39
- TAG-AQA2 - 1179808 - $39
- TAG-PNK1 - 1179824 - $39
- TAG-PNK2 - 1131737 - $39
- TAG-PHT1 - 1131736 - $39
- TAG-YEL1 - 1131740 - $39
- TAG-YEL2 - 1131741 - $39
- TAG-GRD1 - 1179825 - $44
- TAG-GRD2 - 1131734 - $44
- TAG-GEM1 - 1179826 - $49
- TAG-GEM2 - 1131733 - $49
- TAG-GWT1 - 1179827 - $44
- TAG-GWT2 - 1179828 - $44
- TAG-RRD1 - 1179829 - $44
- TAG-RRD2 - 1179834 - $44
- TAG-REM1 - 1179835 - $49
- TAG-REM2 - 1179836 - $49
- TAG-RWT1 - 1179837 - $44
- TAG-RWT2 - 1179838 -$44
- NO TAG REQUIRED
Choose Your TAG (ss)*
- TAG-RED1 - 1131738 - $39
- TAG-RED2 - 1131739 - $39
- TAG-SEM1 - 1179802 - $44
- TAG-SEM2 - 1179804 - $44
- TAG-BLK1 - 1131729 - $39
- TAG-BLK2 - 1131730 - $39
- TAG-WHT1 - 1179805 - $39
- TAG-WHT2 - 1179806 - $39
- TAG-BLU1 - 1131731 - $39
- TAG-BLU2 - 1131732 - $39
- TAG-AQA1 - 1179807 - $39
- TAG-AQA2 - 1179808 - $39
- TAG-PNK1 - 1179824 - $39
- TAG-PNK2 - 1131737 - $39
- TAG-PHT1 - 1131736 - $39
- TAG-YEL2 - 1131741 - $39
- TAG-YEL1 - 1131740 - $39
- NO TAG REQUIRED
Choose Your TAG (YG)*
- TAG-GRD1 - 1179825 - $44
- TAG-GRD2 - 1131734 - $44
- TAG-GEM1 - 1179826 - $49
- TAG-GEM2 - 1131733 - $49
- TAG-GWT1 - 1179827 - $44
- TAG-GWT2 - 1179828 - $44
- NO TAG REQUIRED
Choose Your TAG (RG)*
- TAG-RRD1 - 1179829 - $44
- TAG-RRD2 - 1179834 - $44
- TAG-REM1 - 1179835 - $49
- TAG-REM2 - 1179836 - $49
- TAG-RWT1 - 1179837 - $44
- TAG-RWT2 - 1179838 -$44
- TAG-PNK1 - 1179824 - $39
- TAG-PNK2 - 1131737 - $39
- TAG-PHT1 - 1131736 - $39
- NO TAG REQUIRED
Choose ENCLOSURE OPTION (default is DOUBLE LOBSTER):
All bracelets by default are made to be Interchangeable (DOUBLE LOBSTER) for added convenience and flexibility.
- Interchangeable TAGS (DOUBLE Lobster) *recommended
- NON-Interchangeable TAG (SINGLE Lobster)
***Please remind customer that the bracelet and tag will be permanently linked together and any sizing corrections will require an entire new bracelet and tag set to be ordered.
Choose Your NECKLACE Style*
- MHPM-MED-R - 1131770 - $49
- MHPM-MED-P - 1179857 - $49
- MHSS-MED-R - 1131772 - $59
- LOST-MED-R - 1131768 - $49
- LOST-MED-B - 1131766 - $49
- LCST-MED-R - 1131762 - $49
- LCST-MED-B - 1131760 - $49
- MRP-MED-R - 1131780 - $49
- MRP-MED-B - 1131778 - $49
- MOB-MED-R - 1131774 - $49
Select your 3mm Curb Chain LENGTH*
- 19 inch Curb Chain
- 23 inch Curb Chain
Choose Your LOBSTER CHARM Style*
- CL-MHPM - 1148460 - $39
- CL-MHSS - 1148459 - $49
- CL-LOST-R - 1148463 - $39
- CL-LOST-B - 1148462 - $39
- CL-LCST-R - 1148464 - $39
- CL-LCST-B - 1148465 - $39
- CL-SCST-R - 1179858 - $34
- CL-SHST-R - 1179859 - $34
Measure WRIST SNUGLY
WRIST SIZE*
Measure your wrist snugly, and we’ll add approximately 3/4 inch (0.75") for a comfortable fit. ***Remember, we need the PRECISE wrist size, not what you think the bracelet should be!
MEDICAL Information to Engrave:
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
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Does the customer require additional Bracelets?*
- Yes
- No
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Does the customer require additional Medical ID Tags?*
(can be ordered with any INTERCHANGEABLE DOUBLE LOBSTER bracelet) *** engraved with same Medical Information
- Yes
- No
Choose Your TAG*
- TAG-RED1 - 1131738 - $39
- TAG-SEM1 - 1179802 - $44
- TAG-BLK1 - 1131729 - $39
- TAG-WHT1 - 1179805 - $39
- TAG-BLU1 - 1131731 - $39
- TAG-AQA1 - 1179807 - $39
- TAG-PNK1 - 1179824 - $39
- TAG-PHT1 - 1131736 - $39
- TAG-YEL1 - 1131740 - $39
- TAG-RED2 - 1131739 - $39
- TAG-SEM2 - 1179804 - $44
- TAG-BLK2 - 1131730 - $39
- TAG-WHT2 - 1179806 - $39
- TAG-BLU2 - 1131732 - $39
- TAG-AQA2 - 1179808 - $39
- TAG-PNK2 - 1131737 - $39
- TAG-YEL2 - 1131741 - $39
- TAG-GRD1 - 1179825 - $44
- TAG-GEM1 - 1179826 - $49
- TAG-GWT1 - 1179827 - $44
- TAG-GRD2 - 1131734 - $44
- TAG-GEM2 - 1131733 - $49
- TAG-GWT2 - 1179828 - $44
- TAG-RRD1 - 1179829 - $44
- TAG-REM1 - 1179835 - $49
- TAG-RWT1 - 1179837 - $44
- TAG-RRD2 - 1179834 - $44
- TAG-REM2 - 1179836 - $49
- TAG-RWT2 - 1179838 -$44
- NO TAG REQUIRED
Please select your shipping option:*
EXPRESS Shipments are sent DIRECT TO YOUR STORE via FedEx. Tracking information will be sent via email upon completion of your order.
- EXPRESS SHIPPING ($15 charge will apply) - Turnaround: 1-3 Business Days
- STANDARD SHIPPING (FREE) through HO - Turnaround: up to 2 weeks
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After submission, please also FAX ORDER FORM TO 1-855-909-0277 to confirm EXPRESS shipping option:
Indicate any SHIPPING related special requests or instructions here:
Special Instructions
Please indicate anything not already mentioned in this order
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Supplies Required (optional)
Please select all items required to be shipped along with your order:
- Brochures
- Order Forms
- Replacement samples (missing or damaged)
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Indicate which samples are needed here:

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Need Help?

tel: 1-855-909-0007
fax: 1-855-909-0277

orders@medicengraved.com

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