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 / STANDARD  ARROW  OF   LIGHT®
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.

CHOOSE   PLAQUE   TYPE PRICE
Deluxe Arrow Arrow of Light® Plaque $ 54.95
Standard Arrow of Light® Plaque $44.95
                        Shipping and Handling $ 13.00
California Residents add 7.75% Sales Tax


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


ORDER   SUMMARY
Deluxe Plaque   @   $ 54.95   = 
OR
Standard Plaque   @   $ 44.95   = 
 Subtotal   x   7.75 % Tax *   = 
Shiping & Handling      @    $ 13.00   =  $ 13.00
Grand Total       = 
* California Residents only



"ScoutŪ", "WebelosŪ", and "Arrow of LightŪ" are registered trademarks of the Boy Scouts of America.
Patch Plaques / Eagle Gifts Galore is not endorsed by or affiliated with the BOY SCOUTS OF AMERICA in any way.





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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: ______________________________________________________________________________________


Deluxe / Standard Plaque Order Form © 2012 Eagle Gifts Galore