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Double Image Nameplates
ORDER FORM

Send order form and check or money order to:
DOUBLE IMAGE NAMEPLATES, P.O.BOX 477, PRAIRIEVILLE, LA 70769

Fill in below whether you would like an ornament with your nameplate or just the "name only". If you choose an ornament for your nameplate we will try to give you exactly what you have requested. Ornaments given will sometimes be different than what is pictured though your overall theme will be followed as closely as possible.

Price is based upon number of letters on each nameplate.
$23.00 - up to 8 letters and/or numbers (ornament included).
$20.00 - up to 8 letters and/or numbers (name only, no ornament).
$ 1.00 - for each additional letter/number after 8 characters.
$ 5.00 - shipping and handling fee. Up to 3 nameplates may be included in this fee. Make check or money order payable to DOUBLE IMAGE NAMEPLATES.

PLEASE PRINT

Mail to:
Name_____________________________________________________________________________

Address___________________________________________________________________________

City_____________________________________________State________________Zip___________

Information below is needed for the person for which the nameplate is being made. Please fill in appropriate information so that we may make this nameplate as personable as possible.

CHECK ONLY ONE:
________Name with ornament
________Name without ornament (name only)

NAME or TITLE wanted on nameplate: _______________________________________________________________

_________Male ________Female

Please check appropriate age group: _______0 - 12 months ______1 - 5 years ______6 - 10 years ______16 - 20 years ______21 & up

Choose one color for name: ______blue ______green ______red ______purple

Hobbies: (check ornament of your choice)
_____Hunting _____Sailing _____ Fishing _____Gardening _____Butterflies _____Teddy Bears _____Frogs _____Dinosaurs _____Birds _____Animals
_____Cartoon Characters (list 2 choices - will be made with 1 character)_________________________________ _____Sports (list sport)_______________________________________________
_____Pen set (nameplate with Ballpoint pen in holder)
_____Other (Different ornaments are available upon request. Write down your request and it will be sent if available. If not available an ornament nearest to your request will be sent).__________________________________________

List 3 choices from the above Hobbie list in order of preference (your 1st choice will be sent unless it is not available):
1st choice__________________________________________________
2nd choice__________________________________________________
3rd choice__________________________________________________

Print out this form. Then fill in the information and mail it to Double Image Nameplates. List only one name per form.