ORDER DUPLICATE AWARDS AND CERTIFICATES

FOR YOUR CLIENTS AND YOURSELF

NOTE: All orders must be sent prepaid to the ACW Office no later than July 30, 2011.  We will not accept any orders after that date.

1. Complete the following:  Certificates will be reprinted exactly like the original.  No changes can be made.   Please type text or write legibly.

Indicate the award type:   _____GOLD                _____SILVER                _____BRONZE

Entrant/Client: ___________________________________________________________________

Title:_____________________________________________________________________________

Client/Entrant:___________________________________________________________________

Category:________________________________________________________________________

2. What would you like to order?

          ______ dup certificate(s) unframed at $15 each + $3.00 P/H  TOTAL  $ ___________

                

          ______ dup certificate(s) framed at $40 each + $6.00 P/H           TOTAL  $____________

3.  Shipping instructions.  (Please type or print clearly)

 Name:______________________________________________________________________________________

 Company:__________________________________________________________________________________

 Address:___________________________________________________________________________________

 City:_______________________________________________ State:_________  Zip:___________________

 Phone number where you can be reached:_______________________________________________

  1. Send one form per award and payment in full to ACW.  See deadline above.

Copy this form for more than one award.

  1. You may also pay for your order using your credit card.

Credit Card No. ________________________________________________ Exp. Date____________

Mail or FAX completed form with payment to:

The Advertising Club of Westchester, Inc.

405 Tarrytown Road #1504, White Plains, NY10607

Phone: 914-202-3116

Fax: 914-620-1716