Duplicate Award Form
YEAROFWIN: 20 21 GoldNugget Please use separate order form for each type of merchandise ordered. If separate engraving instructions are required please use a separate form for each. This orderis for: AMOUNT ENCLOSED Merit Award @$175 each $ Gold Nugget Trophy @ $325 each $ Photo Plaque@$275 each $ Home of the Year Trophy @ $375 each $ All items include postage and handling Sales Tax @ 7.75 % (California orders only) $ TOTAL $ ENGRAVING INSTRUCTIONS: Please fill out completely when ordering. You must complete exactly as you wish engraving to appear.
Company Name Project name and Location Category Title Ship to: Name Company Address
City/St./Zip
Telephone Date Please keep a copy of this form for your records. For delivery allow 6-8 weeks. Questions? Contact: Lisa Parrish, Gold Nugget Awards (800) 658-2751 or (909) 987-2758 Fax (909) 987-1335. Send credit card information or check payable to GOLD NUGGET AWARDS, along with this form to: GOLD NUGGET AWARDS, 10416 HAMILTON ST, ALTA LOMA, CA 91701 Visa/MasterCard/Amex No. Expiration Signature Security Code Charges will appear on your credit card as Gold Nugget Awards - Peter M. Mayer Productions OFFICE USE ONLY: DATE: SERIAL # COPY SENT DATE SHIPPED
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