Eagle Gifts Galore
2707 S. DESERT FOREST AVE., ONTARIO, CA 91761   Voice: (909) 947-6634
Fax: (909) 947-6666     e-Mail:  EagleGiftsGalore@gmail.com     http://www.Eagle Gifts Galore.net
EAGLE   SCOUT  POEM  PLAQUE  ORDER  FORM

INSTRUCTIONS
1. Enter your Background Paper choice.   (See Background Papers pages.)
2. Select Poem.  (See Thank You Poem Plaques page for poem choices & wording.)
3. Select Plaque color.1       7. Total your order.
4. Fill in Date plaque is needed by.       8. Fill in your contact information.
5. Enter your Pack # and Council Name.2       9. Fill in payment information.
6. Enter your Personal Message.     10. Print Form, Sign, and mail or fax.

1Some background papers look better in Walnut, some in Black Marble.
Black Marble-Look wood add $ 5.00
If you prefer, we can choose the best plaque color for your background paper choice.
2This information will help us to determine if your leader
has already received the poem you are ordering for him or her.
Use your browser's "Print" feature to print this form, sign it, and Fax or mail it to the address above.

Please do NOT send Credit Card information via eMail.



          Poem Plaque                       $ 34.50 Each 3
Shipping and Handling       $ 16.75
4


California Residents add 7.75% Sales Tax

3Black Marble-Look wood add $5.00
4 Up to three poems ship in the same box for the same price.


POEM INFORMATION
Background Paper:  
Poem Choice:  
My Eagle Scout™ began as a:     Scout™
Select plaque color:  
Date plaque is needed by:   - -
Troop Number:  
Council Name:  

Personal Message
Eagle Scout's™ Name or Line 1
Sentiment or Line 2
Parent(s) Name(s) & Date or Line 3

* * * * * * * * * * * * * * * * * * * * * * * *


ORDER   SUMMARY
  Poem Plaque  @  $ 26.50  =  $   26.50
  California Sales Tax*   @    7.75%    =   $     2.05
  Shiping & Handling   @  $ 13.00  = $  13.00
    Total  =  $  
* California Residents only



Billing Address
  Name          
 Address 1    
 Address 2    
 City              
 State                      Zip      
 E-Mail    
    Main Phone Number
   Home       Mobile  
    - -
  Second Phone Number
   Mobile       Work  
    - -

Shipping Address (if different)
We must have a phone number for the shipping address.
  Name          
 Address 1    
 Address 2    
 City              
 State                      Zip      
    Phone Number
    - -

PAYMENT   INFORMATION:
     Check Enclosed      Credit Card      PayPal    
Send PayPal payments to EagleGiftsGalore@gmail.com
 
CREDIT  CARD   INFORMATION:
Name on Credit Card:
First Name Middle Initial Last Name
Please make sure that the Billing Address (above) is where the credit card statement is sent.
  Credit Card Type:      Visa     Mastercard
CREDIT   CARD   NUMBER: EXPIRATION   DATE: SECURITY   CODE:
    (on back of card)
                  
 
 
Signature: ________________________________________________________________________________

Rev. 03-2018