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
EAGLE   POEM  PLAQUE  ORDER  FORM

If you are ordering a Standard Eagle Poem Plaque, use this form.
For Thank You Poem Plaques, please use the Thank You Poem Plaque Order Form.
For Deluxe Poem Plaques, please use the Deluxe Poem Plaque Order Form.

ORDER  FORM  INSTRUCTIONS
1.Enter your Background Paper choice.   (See Background Papers pages.)
2. Choose Poem.  (See Eagle Poem Plaque page for poem wording.)
3.Fill in ALL required information.   
*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.
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.

          Poem Plaque                       $ 24.95 Each
Shipping and Handling       $ 11.00

California Residents add 8.75% Sales Tax
All prices subject to change.

POEM INFORMATION
Background Paper:  
Poem Choice:  
My Eagle began as a:    
Select plaque color:  
Date plaque is needed by:   - -
Troop Number:  
Council Name:  
Personal Message
Eagle's Name or Line 1
Sentiment or Line 2
Parent(s) Name(s) & Date or Line 3

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





ORDER   SUMMARY
  Poem Plaque  @  $ 24.95  =  $ 24.95
  California Sales Tax*   @    8.75%    =   $   2.18
  Shiping & Handling   @  $ 11.00  = $ 11.00
  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: ______________________________________________________________________________________