Please provide the following ordering information:

QTY		DESCRIPTION
	1. Black Plate/Gold Letters
	2. Gold Plate/Black Letters
	3. Plate for Employee of Month/    Plaque - List Month/Name
	4. Monthly plaque/ EOM  - List Name/Month.
	5. Special/Describe Fully.

	BILLING
Date of this order
Date Needed
Person placing order
Purchase Order #
Account Name, BH=Bill Heard Chev.

	SHIPPING
Do you want us to deliver to Bill Heard the next working Thursday? (Type Yes in box.)
Fill out the next 5 boxes if you wish us to ship this order via UPS.   Street Address
Address (cont.)
City
State/Province
Zip/Postal Code