The Scout Image: Deluxe Thank You Poem Plaque Order Form

THE SCOUT IMAGE
2063 S. HELLMAN AVE., SUITE C, ONTARIO, CA 91761 Voice: (909) 947-6634
Fax: (909) 947-6666 e-Mail: tsi@TheScoutImage.com http://www.ScoutPlaques.com
DELUXE THANK YOU POEM PLAQUE ORDER FORM

If you are ordering a Deluxe Thank You Poem Plaque, use this form.
For (regular) Boy Scout Thank You Poem Plaques, please use the Boy Scout Thank You Poem Plaque Order Form.
For (regular)Cub Scout Thank You Poem Plaques, please use the Cub Scout Thank You Poem Plaque Order Form.

ORDER FORM INSTRUCTIONS
1.	Select Plaque Size.	7.	Enter your Pack or Troop Number ^	11.	Total your order.
2.	Select Brass Color.	8	Enter your Council Name.^	12.	Fill in your contact information.
3.	Select Plaque color.*	9.	Enter your Personal Message.	13.	Fill in payment information.
4.	Fill in Date plaque is needed by.	10.	Enter Scouts' Names.	14.	Print Form.
5.	Enter your Background Paper choice. ** (See Background Papers pages.)
6.	Select Poem. (See Thank You Poem Plaques page for poem choices & wording.)

*Some background papers look better in Walnut, some in Black Marble.
If you prefer, we can choose the best plaque color for your background paper choice.

** Most Background papers are 8-1/2" by 11". They must be trimmed to fit 10"x 8" and 7"x 5" plaques.
Not all background papers are suitable for trimming. Please call for more information.

^This information will help us to determine if your leader has already received the poem you are ordering for him or her.

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.

12" by 15" Deluxe Poem Plaque (with 10" by 8" Poem)	$ 44.95 Each	Shipping and Handling $ 12.00
9" by 12" Deluxe Poem Plaque (with 7" by 5" Poem)	$ 36.95 Each	Shipping and Handling $ 10.00
California Residents add 7.75% Sales Tax

PLAQUE INFORMATION
Select Plaque Size:
Select Brass Color:
Select plaque color:
Date plaque is needed by:	- -

POEM INFORMATION
Background Paper:
Choose a Poem:	Poem

Pack / Troop Number:
Council Name:

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

Personal Message to be Engraved on Brass Plate

The first line is often the Leader's Name, and is usually larger and sometimes in FULL CAPS.

Scouts' Names are generally listed last, after some kind of "Thank You" message.

(Don't forget your Pack or Troop Number, and the Date of Presentation.)

Line 1
Line 2
Line 3
Line 4

SCOUTS' NAMES (Please check for correct spelling.)
Scout 1:			Scout 2:
Scout 3:			Scout 4:
Scout 5:			Scout 6:
Scout 7:			Scout 8:

ORDER SUMMARY

12" by 15" Poem Plaque	@	$ 44.95	=	$ 44.95
Calif. Sales Tax *	@	7.75%	=	$ 3.48
Shipping & Handling	@	$ 12.00	=	$ 12.00
TOTAL

9" by 12" Poem Plaque	@	$ 36.95	=	$ 36.95
Calif. Sales Tax *	@	7.75%	=	$ 2.86
Shipping & Handling	@	$ 10.00	=	$ 10.00
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 INFORMATION:

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 Type:

CREDIT CARD NUMBER:

EXPIRATION DATE

Signature: _____________________________________________________

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