Diploma Plaque Laminators
47381 Sterdley Falls Terrace
Potomac Falls, VA 20165-2476

         (Hit:  CTRL P to Print This Form)          

       THIS form MUST be INCLUDED with EACH Diploma or Certificate Sent to Us. One (1) Order Form PER Plaque Ordered. Please DO NOT Send the GOOGLE Checkout Receipt . Thank you.            

Please BE SURE to carefully package your diploma or certificate using cardboard or a cardboard tube to prevent bending. Please do not send padded diploma covers as they will not be returned.  

Name: (Please PRINT Plainly)
                 
Address: (No P.O. Box)

City:
   State:    Zip:

Choice of Wood Color:
        Mahogany -  Maple -  Walnut -  Black     

Telephone:
    E-Mail Address:    

Where Did You Hear Of Us?               CFS#  
Payment: Secure GOOGLE Checkout: VISA - MC - AMEX - DISCOVER - Check - Money Order

Special Graduation Price: $59.95 plus $10.00 shipping and handling (Continental US) per plaque.  Total: $69.95  Your order will be returned by UPS within approximately 10-14 business days. (VA Residents Total:  $72.95 includes 5% state sales tax) -  INCLUDE One (1) order form for EACH plaque ordered.

Make Checks or Money Orders Payable to:   Diploma Plaque Laminators

VISA - MasterCard - AMEX:  Order SECURELY:  (ALL Orders EXCEPT VA Residents)