Official Illinois Inaugural Gala Commemorative Paperweight
Printable Order Form
Print or type all information
Circle paperweight quantity: 1 3 6 12 24
Name _________________________________________________
Street Address ________________________________________
Apt._________ Suite ____________
City ___________________ State ______ Zip ___________
Phone number _________________________
Phone Number Required or email for processing of order
Phone Number Required or email for processing of order
Attach a check to the form, or put your credit card information below:
Credit card number _____________________________________
Expiration date ___________ Security code _________
| Pricing chart | |||||
| Qty | Price | S&H | Total | For NY residents | International |
| 1 | $25 | $8.95 | $33.95 | $36.88 | $42.44 |
| 3 | $48 | $8.95 | $56.95 | $61.85 | $71.19 |
| 6 | $90 | $8.95 | $98.95 | $107.48 | $123.69 |
| 12 | $180 | $15.95 | $195.95 | $212.85 | $244.94 |
| 24 | $360 | $24.95 | $384.95 | $418.15 | $481.19 |
Fax all credit card orders to a secure dedicated fax# 866 284-3297
Or mail this form to:
Customlaserawards
Box 1517
Stony Brook, NY 11790-1517
Or mail this form to:
Customlaserawards
Box 1517
Stony Brook, NY 11790-1517