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

RESIN  EAGLE  PLATE  PLAQUE 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     Date plate is needed by:
Line # 2     - -

ORDER   SUMMARY
Plaque Type:            
California Sales Tax*       @   8.75%           =  
Shiping & Handling     @   $   12.00       =      $  12.00
        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: ______________________________________________________________________________________