Preferred Customer - Brownlee Jewelers

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- Chamilia

Our Specials

Name:

E-mail:
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Receive the benefits of a Brownlee Jewelers Valued Customer: It's easy. Just let us know your personal preferences to receive exclusive offers and invites as well as previews to new products.

Your Information:

First Name:*
Last Name:*
DOB:
Email:*
Address:*
City:*
State:*
Zip:*
Phone Number:*

Spouse Information:

First Name:
Last Name:
DOB:
Anniversary:

Children:

Child Name1:		Child DOB:
Child Name2:		Child DOB:
Child Name3:		Child DOB:
Child Name4:		Child DOB:
Child Name5:		Child DOB:

1. Preferred Store Location:

	Stonecrest, Charlotte, NC North Carolina
	Park Road Shopping Center, Charlotte, NC North Carolina
	The Arboretum, Charlotte, NC North Carolina
	South Lake Shopping Center, Cornelius, NC North Carolina
	Manchester Village, Rock Hill, SC South Carolina
	Town Center, Charlotte, NC North Carolina
	Downtown Charlotte, Charlotte, NC North Carolina
	Ballantyne, Charlotte, NC North Carolina

2. What are your Favorite Brand(s)?:

3. Choose Your Favorite Product(s):

	Necklaces and Pendants
	Earrings
	Bracelets
	Watches
	Rings
	Pins and Brooches
	Family Jewelry
	Men's jewelry

4. Select Your Favorite Material(s):

	White Gold
	Yellow Gold
	Platinum
	Palladium
	Alternative Metals like Stainless Steel & Tungsten Carbide

5. Select Your favorite gemstone(s):

	Diamonds
	Pearls
	Precious Gemstone (Ruby, Sapphire, Emerald)
	Semi-Precious Gemstones (Aquamarine, Citrine, Peridot, Blue Topaz, etc.)

Yes No6. Send Me Exclusive In-Store Offers and Events?

7. Is There Something That You Would Like to Find at Our Stores in Your Next Visit?

8. Where do you prefer to shop?

	Online only
	In store only
	Both

9. How did you hear about us?

	Television
	Radio
	Newspaper
	Website
	Walking by
	Facebook
	Twitter
	Friend/Referral