SHIPPING NAME
SHIPPING COMPANY:  
SHIPPING ADDRESS:  
SHIPPING CITY, STATE, ZIP:    
PHONE:    
FAX:    
EMAIL ADDRESS:    
Valid email is REQUIRED. Custom changes must be emailed and approved before your order can be started.

DATE ITEMS NEEDED BY:
To ensure accuracy PLEASE include the Stock # AND the filename of your design(s)

STOCK # 
DESIGN FILE NAME DESCRIPTION:
CUSTOM FILE NAME (emailed to you):
TYPE: PLAQUE
QUANTITY:
TOP MEDALLION DESIGN CHANGES:
BOTTOM TEXT:

OTHER CHANGES: 

(DUPLICATE ABOVE FOR EACH ITEM) 

ADDITIONAL INFO:

#PLAQUES:                    x $4.50 = $        
     

SubTotal $

Shipping $
($6 Priority Mail for the up to 2 plaque, plus $1 each additional plaque)

Total Due $

Pay by Paypal:
Pay by Check sent on:     

Allow approximately 2 weeks for receipt of finished order with priority mail shipping,   
Delivery times may be slower during the April/May awards season.

You will receive an emailed confirmation of this order.