Eagle Gifts Galore / Patch Plaques: Arrow Mounting Plaque Order Form

EAGLE GIFTS GALORE
2063 S. HELLMAN AVE., SUITE C, ONTARIO, CA 91761 Voice: (909) 947-6634
Fax: (909) 947-6666 e-Mail: egg@eaglegiftsgalore.net http://www.PatchPlaques.net
ARROW MOUNTING PLAQUE ORDER FORM

Fill in this form, then Use your browser's "Print" feature
to print it, sign it, and Fax or mail it to the address above.

Please do NOT send Credit Card information via eMail.

ENGRAVING INFORMATION
Name or Line 1
Pack or Troop # or Line 2
Date or Line 3
Date plaque is needed by:	- -
Council Name

QUANTITY	WOOD COLOR	BRASS COLOR
Enter the # of each color of plaque below, then choose the brass plate color.

OUT OF STOCK	Blue Marble-Look Wood	Blue Brass

	Cherry Finish Wood	Gold Brass

	Flat Black Finish	Black Brass

ARROW MOUNTING PLAQUE		$ 22.95*
Shipping & Handling (First Plaque)		$ 10.00
Additional Plaque Shipping & Handling		$ 3.00 each

Includes Arrow Mounting Clips. Arrow NOT* included.
California Residents add 7.75% Sales Tax

* * * * * * * * * * * * * * * * * * * * * * * *

ORDER SUMMARY
Arrow Mounting Plaque(s)	@	$ 22.95	=
California Sales Tax**	@	7.75%	=
First Plaque Shipping & Handling	@	$ 10.00	=	$ 10.00
Add'l. Plaque Shipping & Handling	@	$ 3.00	=
Total			=
** California Residents only.

Billing Address
Parent's Name
Address 1
Address 2
City
State	Zip
Home Phone - -	Cell/Work Phone - -
E-Mail

Shipping Address (if different)
Parent's Name
Address 1
Address 2
City
State	Zip
Phone - -
We must have a phone number for the shipping address.

PAYMENT INFORMATION:

Check Enclosed

Please charge my Credit Card

Credit Card Type: Visa Mastercard

Name on Credit Card:

First Name

Middle Name

Last Name

Please make sure that the Billing Address (above) is where the credit card statement is sent.

CREDIT CARD NUMBER:

EXPIRATION DATE:

SECURITY CODE:
(on back of card)

Signature: ______________________________________________________________________________________