Please use this form to order your custom Masonic Past Master's Jewel. If you like, you may also e-mail us at info@insignia-emblematic-creations.com for more information.

After completing this form, you will recieve a confirmation email. Please print the email and include it with your payment.

Your personalized jewel will be created after payment is received. Payment instructions are at the bottom of this form and will also be included in your confirmation email.

Please be sure your phone number and email address are accurate so that we may contact you if we have any questions about your jewel.

We thank you for your interest in getting your jewel from Insignia Emblematic Creations.

First Name	*
Last Name	*
Email	*   be sure to enter a valid e-mail address
Address	*
Address 2
City	*
State	*
Zip	*
Phone #	*
Fax

Lodge Number: *  
Year Bar (s): *   Presented to Bro. *   , P.M. By:*  
Lodge No. *    F. & A. M.
On December 27th, *  


The cost of the Sterling Silver Past Master's Jewel is
$335.00 plus
$12.00 shipping
$20.82 state sales tax
Total: $367.82

The cost to add a year bar to an existing jewel is $45.00 plus $12.00 and $3.42 state sales tax for a total of $60.42

Price includes engraving and case.

Please forward your payment to:

Insignia-Emblematic-Creations, LLC
P.O. Box 100
Bala Cynwyd, PA 19004