Order Form

Order Form
No cancellations after 24 hours. Delivery within 1-2 weeks
For Dealer Use Only
- Customer Code
- Dealer Number
- Dealer Name
Address
Street Address City State / Province / Region ZIP / Postal Code
- Phone
- Fax
- Email*
- Purchase Order No.
Drop Ship Information
- Consumer Name
- Consumer Phone
Address
Consumer Drop-Ship Information (Do not use P.O. Box.)

Street Address Apt # City State / Province / Region ZIP / Postal Code
- 1. Item Code
  
  (Refer to literature for 4- or 5-digit item code.)
- 2. Item Description
  
  Name/Style
- 3. Quantity
For Personalized items, please also complete steps 4 -8
- 4. Plaque Size (if applicable):
  - Estate
  - Standard
  - Petite
- 5. Mounting (if applicable):
  - Wall
  - Lawn
- 5. Color Code
  
  (Refer to literature for choices and 2- or 4-digit color code.)
- Color Name:
- Monogram Initial
  
  (for Monogram Plaques ONLY, or leave blank for scroll design)
- 7. Personalization
  Important: Personalization options vary. Please refer to the literature for details on the number of spaces, and numbers and/or characters available on your item.
- Line 1:
- Line 2:
- Line 3:
- 8. Mailbox/Post Sign Ornament Code
  
  (If applicable. Refer to literature for 4-digit code.)
- 8b. Mailbox/Post Sign Ornament Code
  - Color
  - Black
- Ornament Name:
9. Special Instructions
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For Dealer Use Only