Terryberry Nursing Pins 2033 Oak Industrial Drive NE Grand Rapids, MI 49505

ORDER DEADLINE:
Tuesday, April 1st, 2014

UNIVERSITY OF TEXAS AT ARLINGTON ORDER FORM

1. ----------------------------------Student Information---------------------------------Natasha Bynaum
Order Date:
*Pins orders must be placed by above deadline date to ensure delivery prior to the ceremony. Pins will not be manufactured until payment is received in full.

Name:

Street Address: City:

1801 Estates Dr
State:

Mansfield

TX
Work/Cell:

Zip:

76063

Telephone (Home): Email Address:

682-225-4108

2.

----------------------------------Order Information----------------------------------

Metal Quality- Please check box beside quality desired & enter price in payment section: Gold Plate ($30.82) Silver Plate ($30.82) Sterling Silver ($46.21) Gold-Filled ($90.54) 10 Karat Gold ($308.56) 14 Karat Gold (Quote on Request) Gold Color (Circle One): Yellow White

Choose Finding- Please select the backing of your pin (how the pin will attach to clothing): Lapel Tac Pin Back

Engraving (Extra $2.15) - If desired, please enter two initials & graduation year:

3.

2014 NB Year of Graduation: ----------------------------------Payment Information---------------------------------2 Initials: Pin Price From Above: $ Engraving ($2.15):$ Subtotal: $ Shipping Charge: $
Exp. Date: /

Method of Payment Please check one:

Check or Money Order enclosed payable to Terryberry Visa MasterCard American Express

2.15

Credit Card Number: Security Code: Card Holders Name: Card Holders Signature:

$0.00

______

Sales Tax (8.25%):$ Final Total: $

Questions? Danny Zbikowski dzbikowski@terryberry.com 800.253.0882 x 3079 Mail Order Form To: Terryberry Danny Zbikowski 2033 Oak Industrial Drive NE Grand Rapids, MI 49505

Paying by check/money order?

Make payable to: Terryberry