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Please make your selection below and then print this form out on your printer.

Request:  Embossed Dog Tag- The prices are for 1 set of dog tags that include a standard issue 27" ball chain, a 4.5" ball chain and two silencers, black or clear

____________________________________________________________

Character limits including spaces and punctuation!
Line 1: (Maximum 15 Characters) Normally Last Name
Line 2:(Maximum 16 Characters) Normally 1st Name Middle Int
Line 3:(Maximum 16 Characters) Normally Service Number
Line 4:(Maximum 16 Characters) Normally Blood Type
Line 5: (Maximum 15 Characters) Normally Religion


After printing, complete this form and mail with your remittance to:

Northwest SilverSmithing & Ceramics
5010 South Yakima
Tacoma, WA 98408

Ship to:

Name: __________________________

Address: ________________________

City: ___________________________

State, ZIP: ____________________

Phone Number________________

email______________________



Dog Tag/Type Ordered: ____________________
Washington Residents add
sales tax 8.8%: ___________________

Shipping: ________________________
US Postal Service - $2.00 per Tag
Add 25cents per extra tag

Total: ___________________________
Visa/MasterCard/American Express/Discover or Paypal AcceptedAccount #: _________________________

Expiration Date: ____________________

Authorization Code on back of card- last three digits                              

Signature: _________________________

Products
Can be viewed on our secure site at www.allgavesome.us

Delivery approx 1 week

05/22/05

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