Refocus Laser Engraving & Design Phone: (541) 968-2347

Wings Order Form

Name:___________________________

Address:_________________________

City:_____________________________

State:___________Zip:______________

Phone:_________________________

Email:______________________________

Shipping Information:

Ship to:________________________________

Address:_______________________________

City:___________________________________

State:______________Zip:_________________

Quantity Item Name & Description Size Price Each Total Price
    8 x 10 $25.00  
Shipping & Handling - $5.00 First Plaque
Add $1.00 for each additional plaque		  
Total  
Please Allow 2-3 Weeks for Delivery

       Wings Personal Contract:

Contract Text - Please Print Clearly with Desired Punctuation:
 
 
 
 

Cherry Plaque
Name and Date ( If Desired ) - Please Print Clearly:
 
 

Alder _____
Cherry _____

Method of Payment:
Check___ Money Order___
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