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 / PHOTO  TREK  PLAQUE   ORDER  FORM

ORDER  FORM  INSTRUCTIONS
Be sure to fill in ALL information. CHECK   YOUR   SPELLING.
Enter name EXACTLY the way you would like it to appear. Maximum 30 spaces.
Enter the Month, Day, and Year each rank was earned in the boxes next to the rank names.
Use your browser's "Print" feature to print this form, sign it, and Fax or mail it to the address above.
All prices subject to change.

Please do NOT send Credit Card information via eMail.

Eagle Trek Plaque            $ 64.95
Photo Trek Plaque            $ 74.95
Shipping and Handling     $ 13.00

Rank Badges   NOT  Included.
 
PLAQUE  INFORMATION:
Boy's Name:    
Troop Number:    
RANK  DATES:
Scout:   -   -
Tenderfoot:   -   -
Second Class:   -   -
First Class:   -   -
Star:   -   -
Life:   -   -
Eagle:   -   -
SELECT   PLAQUE   COLORS
 
Court of Honor Date OR  Date Plaque is Needed By:**
-   -
 
Council Name: 
 
** Please allow 2 to 3 weeks for delivery.  Rush orders available for an additonal charge.  Please call for details.

ORDER   SUMMARY
  Eagle Trek Plaque   @   $ 64.95   = 
  Photo Trek Plaque   @   $ 74.95   = 
    Sales Tax   @   8.75 %*   =   
    Shiping & Handling   @    $13.00   =   
    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 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: ______________________________________________________________________________________