UBA HONOR SCORE FORM

Male
Female
Left
Right
Yes
No
Yes
No
300 Game
800 Series
Yes
No
Siladium No Charge
Gold Siladium add’l cost of $50.00
Siladium Two-Tone Men:$200.00 Women: $160.00
10K Yellow Gold Men: $625.00 Women: $425.00
14K Yellow Gold Men: $875.00 Women: $525.00
No
Standard side – No Charge
Signet Panel (No Charge)
CZ Zenith Stone add’l $50.00
10K Yellow Gold $75.00
Diamond Zenith Stone $150.00

* Required