Worldwide Brass Products

Medallion or License Tag Order Form

Complete the following Order FORM to place your order for a brand new house number plaque.

When finished click SUBMIT ORDER at the bottom to send us your order.

For larger quantity orders e-Mail or call 904-646-3925

Important: This ORDER represents a FIRM commitment to purchase the item once the Credit Card information is completed and the Order Form is submitted.

Your Name:

Your E-Mail address:

Mailing Address:

      NOTES: If cc address is different please put it in the comment section below.

City:    State:      ZIP:                    

Phone:

Buy Medallion only - Price each below:

Description Price Dimensions (width x height)
Fireman Maltese Cross $25 6" x 6.5"
Navy Pilot Wings $25 9" x 3.5"
Navy NFO Wings $25 8.75" x 2"
Tennis Rackets $10 4.5" x 4.5"
Lions Head $10 4.5" x 4.75"
Maple Leaf $10 6" x 5.75"
Golf Clubs $10 5" x 5"
Pineapple $10 3" x 5.75"
Seashell $8 4.5" x 4"
Dolphin $10 7.5" x 3.5"
Jaguar $15 6" x 5"

 

   Choose  Medallion

 

Stainless Steel License Tag

Price is $45.00 - choose 1 Medallion or 3 letters per tag: 

    Tag with Medallion  -  Specify Medallion:

 

    Tag with up to 3 4 inch letters  -  Choose letters:

 

Shipping via Parcel Post or First Class:

  • Standard Shipping Price is

    • $5.00 each per Medallion or

    • $8.50 each per License Tag

Credit Card Information (Enter below): cc charge will be from "Beaches Brass Polishing"

Select Type Credit Card: VISA or Mastercard only

Name on Credit Card:

CC Number:

Exp Date:    Security Code (3 digits on back):

Comments:

  

Call if you need help with this ORDER (904) 646-3925

 

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Last Updated: Tuesday, 19 August 2008