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

COPPER  EAGLE  IN  FLIGHT   ORDER  FORM

Fill in this form print it, sign it, and Fax or mail it to the address above.
Please do NOT send Credit Card information via eMail.
All prices subject to change.

ENGRAVING  INFORMATION
(Maximum 40 spaces per line)
Line # 1     Today's Date:
Line # 2     - -
Line # 3     Date Plaque is Needed By:
Line # 4     - -

PLAQUE   INFORMATION   AND   ORDER   SUMMARY
Item Price Ship. & Hand Sales Tax* TOTAL
Copper Eagle in Flight $ 51.95 $ 23.00  
* Sales Tax @ 7.75%  for California Residents only


Billing Address
  Name          
 Address 1    
 Address 2    
 City              
 State                      Zip      
 E-Mail    
    Main Phone Number
   Home       Mobile  
    - -
  Second Phone Number
   Mobile       Work  
    - -

Shipping Address (if different)
We must have a phone number for the shipping address.
  Name          
 Address 1    
 Address 2    
 City              
 State                      Zip      
    Phone Number
    - -

PAYMENT   INFORMATION:
     Check Enclosed      Credit Card      PayPal    
Send PayPal payments to EagleGiftsGalore@gmail.com
 
CREDIT  CARD   INFORMATION:
Name on Credit Card:
First Name Middle Initial Last 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: ________________________________________________________________________________
Rev. 03-2018