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         Plaque Order Form  

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Please provide the following contact information:

First Name

Last Name

 
Organization    
Street Addr. 

Addr. (cont.)

 
City

State/Province

 
Zip Code

Country

 
Phone #

Fax #

 
E-mail    

Please provide the following ordering information:

BILLING      
Purchase Order #

Account Name

 

SHIPPING
     
Street Addr

Addr. (cont.)

City

State

Zip Code

Country

    Enter Quantity:      Enter Date Needed By:    (mm/dd/yyyy)

 

  * If you seen a plaque style in one of our supplier's catalogs, please indicate the Supplier's name and Plaque # below.

     JDS Industries, Inc.        
    Supplier's Name:       Suppliers Plaque#  

 

    Plaque Size:        Plaque Color:

     Plaque Orientation:

    Print Method/Style:

     Plate Material:         Plate Corner Style:

    Plate Color:

     Plate Size:     Height   x Width

    If Plaque requires more than one plate, specify sizes here: (Optional)

                    Additional Plate Size:     Height   x Width
                    Additional Plate Size:     Height   x Width  

    Back Plate:      Back Plate Corner Style:

    Back Plate Color:

    If Individual Plates are required, how many:

    Additional Features Required on Plaque

         

        Plaque Text:
                             
                
          

    Additional Information or Comments:

After the order is received, we will contact you to verify the order, supply you with the detailed pricing, and to get additional billing information.

    Return to Plaque Page

 


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Revised: 02/10/11

 

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