Fill in and print this form, sign it, and Fax or mail it to the address above.

---

ANIMAL	QUANTITY	ANIMAL	QUANTITY
Beaver Bobwhite Fox Owl Eagle Brown Bear Black Bear Black Buffalo Pronghorn Antelope Select Patch 1		Beaver Bobwhite Fox Owl Eagle Brown Bear Black Bear Black Buffalo Pronghorn Antelope Select Patch 2
Beaver Bobwhite Fox Owl Eagle Brown Bear Black Bear Black Buffalo Pronghorn Antelope Select Patch 3		Beaver Bobwhite Fox Owl Eagle Brown Bear Black Bear Black Buffalo Pronghorn Antelope Select Patch 4
Jumbo 5-1/2" Round Patches . . . . . . . $ 10.00 each.
Shipping & Handling:		1 - 2 Patches   3 + Patches	$   3.00  $   6.00
California Residents add 8.75% Sales Tax.  Orders of 1-2 Patches will ship First Class.
Orders of 3 or more Patches will ship Priority Mail. Call for Quantity Discount on orders of 20 Patches or more.

ORDER   SUMMARY
Total # of Patches	@	$   10.00	=	$
Calif. Sales Tax *	@	8.75%	=	$
Shiping & Handling	@	$	=	$
Total Order			=	$
* California Residents only

Billing Address
Parent's Name		Home Phone     - -
Address 1		City
Address 2		State	Zip
E-Mail		Cell/Wk Phone     - -

Shipping Address (if different)
Name		Phone     - -
Address 1		City
Address 2		State	Zip

---

EAGLE   GIFTS   GALORE
2707 S. DESERT FOREST AVE., ONTARIO, CA 91761   Voice: (909) 947-6634
Fax: (909) 947-6666     e-Mail:  egg@EagleGiftsGalore.net     http://www.EagleGiftsGalore.net
WILD  BEAST  ANIMAL  JUMBO   PATCH  ORDER  FORM   PAGE   2

---

PAYMENT   INFORMATION:
Check Enclosed	Please charge my Credit Card
CREDIT  CARD   INFORMATION:
Name on Credit Card:
First Name	Middle Name	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: ______________________________________________________________________________________