EAGLE GIFTS GALORE
2707 S. DESERT FOREST AVE.,ONTARIO, CA 91761   Voice: (909) 947-6634
Fax: (909) 947-6666
e-Mail:   egg@eaglegiftsgalore.net     http://www.PatchPlaques.net

DELUXE  ARROW  CEREMONY
PATCH  PLAQUE  ORDER  FORM

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

Enter the date each rank was earned in the boxes next to the rank names.   If exact date is not known, enter month & year, or 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.


PLAQUE   TYPE PRICE
Deluxe Arrow Ceremony Patch Plaque $ 54.95
Standard Arrow Ceremony Patch Plaque $44.95
Shipping and Handling $ 11.00
California Residents add 8.75% Sales Tax

PLAQUE  INFORMATION
Name    
Pack Number   Date plaque is needed:   - -
Rank Patch ouline will be Oval unless box is checked.   Diamond Patch
Rank Patch Date:             - - Arrow Patch Date:          - -

ORDER   SUMMARY
Deluxe Plaque   @   $ 54.95   = 
Standard Plaque   @   $ 44.95   = 
 Subtotal   x   8.75 % Tax *   = 
Shiping & Handling      @    $ 11.00   =  $ 11.00
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: SECURITY   CODE:
    (on back of card)
                  
 
 
Signature: ______________________________________________________________________________________