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.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 $ 49.95 $ 15.00  
* Sales Tax @ 8.75%  for 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: ______________________________________________________________________________________