PatchPlaques
Clock Introductory Special
Would you like the personalized version of
the clock? (Yes / No)
If your patch is valuable, we recommend that you insure
it when you send it to us.
In the event that PatchPlaques.com loses or accidentally
destroys your patch, we will replace it when possible or
refund the replacement cost, not to exceed twenty five dollars
($25.00), as exclusive remedy. Please send your patch, this completed order form, and your payment via
U.S. Postal Service to:
PatchPlaques.com If you are sending via UPS, FEDEX or DHL then send your
payment to:
PatchPlaques.com If you have any questions about your order, contact us at:
Phone, toll free, (888) 671-2130
Fax at (386) 676-9117
We sincerely appreciate your business!
© 2002-2007 PatchPlaques.com
Clock
Plaque Order Form
PATCH INFORMATION
Enter the description of the patch that you would like made
into a clock:
CLOCK PERSONALIZED
Up to 4 lines of text (28 characters/line max.
including punctuation and spaces)
Line 1:
Line 2:
Line 3:
Line 4:
ORDER PRICING
Total of ________ Clock(s) ordered at
$44.95 each
=
$ _____________
Total of ________ Personalized Clock(s) at
$57.90 each
=
$ _____________
Total of ________ Clocks(s) shipped at
$6.95 each
=
$ _____________
Florida
Residents
add 6.5% sales tax
=
$ _____________
Total
=
$ _____________
SHIPPING INFORMATION (additional charges apply for
coutside continental USA shipments)
Name:
Street Address:
Suite/Apt.:
City:
State:
Zip:
Phone (Days):
(Eves):
Email address:
BILLING INFORMATION (leave blank if address is the
same as shipping address)
Name:
Address:
Suite/Apt.:
City:
State:
Zip:
Phone (Days):
(Eves):
METHOD OF PAYMENT
Check or Money Order
Account #:
Expiration:
Signature:
Security Code:
INSTRUCTIONS
NOTICE
P.O. Box 250180
Daytona Beach, FL 32125
338 Parque Drive, Suite F
Ormond Beach, FL 32174