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
BUDGET  ARROW  CEREMONY  PLAQUE  ORDER  FORM

If you are ordering a plaque for your Son only, use this form.  If you are ordering plaques
for several boys in your group, it is not neccessary to fill out a separate form for each boy,
just use the Budget Multi Plaque Order Form

*Enter the Date the Arrow Patch was (or will be) earned, in the boxes provided.
NOTE: If exact date is not known, just enter the month & year, or the year only.
Use your browser's "Print" feature to print this form, sign it, and Fax or mail it to the address above.

Please do NOT send Credit Card information via eMail.


Quantity Discount
Due to the LOW price of this plaque, Budget Plaques do NOT qualify for the Quantity Discount.

PLAQUE  INFORMATION
 
Boy's Name
 
Pack Number
 
Date plaque is needed by:   - -
 
Arrow of Light Date:   - -
ORDER   SUMMARY
 
Budget Plaque   @   $ 19.95   =    $  19.95
 
    X   7.75 % Tax *   = 
 
Shiping & Handling      @    $9.00   =    $    9.00
 
GRAND   TOTAL   = 
* California Residents only



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



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



PAYMENT   INFORMATION:
  Check Enclosed
  Please charge my Credit Card
CREDIT  CARD   INFORMATION:
Name on Credit Card:
First NameMiddle NameLast Name
Please make sure that the Billing Address (above) is where the credit card statement is sent.
  Credit Card Type:      Visa     Mastercard
CREDIT   CARD   NUMBER: EXPIRATION   DATE
        
Signature: _____________________________________________________