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
MY  TRAIL  PLAQUE  ORDER  FORM

Price includes engraving of ALL rank, pin, and patch outlines.
Custom plaques are available for an additional charge*.   Please call for custom prices.
Enter the Month, Day, and Year each rank was earned in the boxes next to the rank names.
*If Religious Knot was not earned, do not enter a date. Outline for knot will NOT be engraved if no date is entered.
If exact date is not known, just enter the month & year, or the year only.
Check to make sure you have entered the information for EVERY section of the Order Form.
Use your browser's "Print" feature to print this form, sign it, and Fax or mail it to the address above.
Prices subject to change.

Please do NOT send Credit Card information via eMail.

ENGRAVING   INFORMATION
Line 1   Boy's Name  
Line 2   District or Charter Organization Name  
Line 3   Council Name 
Tiger - - Pack Number:      
Bobcat - - AoL Award         - -
Wolf - - World Cons.:       - -  
Bear - - Religious Knot:       - -
Web. - - Check here for Diamond Web. patch
  Date Plaque is Needed By:   - -
Plaque Wood Color:      Walnut Finish     Blue Marble-Look
ORDER   SUMMARY
  My Trail Plaque   @    $ 94.95   = 
  Sales Tax   @     8.75 %*   =   
  Shipping & Handling   @    $ 16.00   =   
  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: ______________________________________________________________________________________