ORDER FORM Order Form Company Name

NAME
 
PHONE
ADDRESS EMAIL
QUANTITY ITEM # / DESCRIPTION UNIT PRICE AMOUNT

 

ORDER INSTRUCTIONS

  1. Complete purchase selections.
  2. Complete order form.
    One (1) plaque, add $4.95 shipping.
    Additional items we will calculate shipping and taxes and email back the Total Price.
  3. Pay for your purchase with paypal.
    You may also send a money order with your order form.
SUB TOTAL
SHIPPING
PA 6% SALES TAX
TOTAL