7164 Graham Rd, Suite 124 · Indianapolis, IN 46250 · (T) 866.573.9429 · (F) 317.466.1384 · www.BoatmanGeller.com

Check Order Status, Current Turnaround Schedule and Latest Info at http://dealer.boatmangeller.com

P L AT E / P L AT T E R O R D E R F O R M

Date _____ /_____ /_________ Account #______________ PO #_______________ SHIPPING Ground 2nd Day Next Day

Company Name ______________________________________________________ DROP SHIP INFO Signature Required Upon Delivery

Company Address ____________________________________________________ Customer Name ____________________________________

City ___________________________________ State ______ Zip _____________ Address __________________________________________

Phone ( _____ ) ________- ___________ Fax ( _____ ) ________- ___________ City ____________________________________________

Email _____________________________________________________________ State ______ Zip ____________

EXTRAS Email Proof, $10 Fax Proof, $10 BOTH Email and Fax Proofs, $15 INTERNAL USE ONLY

PLEASE NOTE PLATE/PLATTER ORDERS CAN NOT BE submitted as PRIORITY RUSH

Customer Approval __________________________________________________ Date _____ /_____ /_________

All type placement, sizing and spacing will follow the sample unless otherwise instructed.PLEASE PRINT CLEARLY. Please Underline All Capital Letters.

Order Parts* part ______ of ______

Item NumberOR

Customization Number

Fill in the boxesappropriately in accordance with

the catalog

Plate StylePattern ColorAccent Color

Quantity

PERSONALIZATION

Typestyle Number/Name

Type Color

Type Case Upper & Lower BIG & SMALL CAPS

lower case UPPER CASE

Text Placement Top Center Center Bottom Center

Monogram Style single monogram

classic monogram

circle monogram

script monogram

Special Instructions

Layout for best appearance Match sample on page ______

INTERNAL USE ONLY order entry: credit: typesetting: quality control:

BjBg

jBgjB7

*Please note that all plate/platter orders are processed and shipped separately from other Boatman Geller personalized orders. Plate orders can not have order parts from items in the other Boatman Geller Personalization Kit Catalogs. Also, shipping charges cannot be combined with orders from items in the other Boatman Geller Personalization Kit Catalogs.