Ring Protection Plan (Lost Ring) Claim Form

Claims must be filed by the original owner within 4 years of shipment of your original order or within 10 years of shipment of your original order if you purchased the High School Extended Ring Protection plan. Only one ring loss protection claim accepted per ring. Harley Davidson, College championship, military academy rings, diamonds and genuine stones are not covered. Cubic zirconia and/or synthetic stones will be substituted. For quotes on genuine stone replacement call 1-800-854-7464.

Original Owner: First Name and Middle Initial

Last Name

Date (mm/dd/yy)

Address Line 1

Address Line 2

City

State

Zip

Phone Number

Email Address

Your phone number and email address will only be used to contact you with questions regarding this request.

School Name High School College

School City

School State

Graduation Year

Degree (if applicable)

ADDITIONAL INFORMATION:

Signature - sign your name between the brackets if your original order had your signature for inside engraving

REPLACEMENT FEE INFORMATION

Select the replacement fee that applies to your original ring. College Jewelry (Lustrium, Yellow Lustrium) College Jewelry (10-kt.) College Jewelry (14-kt.) College Jewelry (Silver Elite) College Jewelry (Solaris Elite) College Jewelry (18-kt.) High School Jewelry (Lustrium, Yellow Lustrium) High School Jewelry (10-kt.) High School Jewelry (14-kt.) High School Jewelry (DualCast) High School Jewelry (Silver Elite) High School Jewelry (Solaris Elite) High School Jewelry (Platinum, 18-kt.)

Prices subject to change.

TOTAL Replacement Fee Shipping & Handling Sales Tax
if applicable with tax, shipping Claims must be filed by the original owner & handling within 4 years (or 10
years if you purchased the High School Extended Ring Protection plan) of shipment of your original order.

$ $ $ $ $ $ $ $ $ $ $

100.00 265.00 450.00 200.00 230.00 55.00 250.00 380.00 110.00 100.00 140.00

$ $ $ $ $ $ $ $ $ $ $

9.99 9.99 9.99 9.99 9.99 9.99 9.99 9.99 9.99 9.99 9.99

Call for Quote 1.800.563.7603

Call for Quote 1.800.563.7603

College championship and military academy rings, diamonds and genuine stones are not covered. Cubic Zirconia and/or synthetic stones will be substituted. For quotes on genuine stone replacement call 1-800-854-7464

PAYMENT INFORMATION
Payment must be received with the replacement order. DO NOT SEND CASH. Check Money Order Debit/Credit Card: Card # Signature The undersigned acknowledges that their Jostens jewelry has been lost or stolen and this form and payment is for the one-time replacement order of their class jewelry. The undersigned understands this payment is non-refundable after 72 hours (3 business days) from the date of receipt at Jostens. Signature Please keep a copy of your completed and signed form for your records. Mail your claim to: Warranty Service Center Ring Protection Plan 1900 Hartle Ave Owatonna, MN 55060
2012 Jostens, Inc.

Visa

MasterCard

American Express Expires

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(mm/yy)

Date