| A: Ordered By | B: Shipping or Gift Address |
| Name: |
Name: | ||
| Address: | Address: | ||
| City, State Zip: |
City, State Zip: |
||
| Daytime Phone: |
Telephone Phone: |
||
| Evening Phone: |
Message: | ||
| Email Address |
Special Instructions:
|
Available Print Styles:
![]()
| Product Description |
Qty | Metal Type | Block Roman or Script? (Above) |
Engraving information: | Ship to A or B |
Price Each |
Total Price |
| Shipping, Handling &
Insurance: (Continental US only) |
Additional Charges: | Merchandise Total: | |||
| Delivery Charge (per address): |
|||||
| $0-$25.00 $25.01-$50.00 $50.01-$75.00 $75.01-$100.00 $100.01-$200.00 |
$ $ $ $ $ |
|
|||
| FL Residents add 6.5% Sales Tax: |
|||||
| TOTAL: | |||||
| If Paying by Credit Card: ________________________________________________ _______________ ________________________________________________ Please fax your order to (561) 422-1966 - * Press send when recording goes on. |