Please provide the following contact information:

First Name		Last Name
Organization
Street Addr.		Addr. (cont.)
City		State/Province
Zip Code		Country
Phone #		Fax #
E-mail

Please provide the following ordering information:

BILLING
Purchase Order #		Account Name

SHIPPING
Street Addr		Addr. (cont.)
City		State
Zip Code		Country

    Enter Quantity:      Enter Date Needed By:    (mm/dd/yyyy)

  * If you seen a plaque style in one of our supplier's catalogs, please indicate the Supplier's name and Plaque # below.

     JDS Industries, Inc.        
    Supplier's Name: Choose Supplier's Name JDS Industries, Inc AirFlyte PDU       Suppliers Plaque#  

    Plaque Size: Choose Plaque Size 4 x 6 5 x 7 6 x 8 7 x 9 8 x 10 9 x 12 10-1/2 x 13 12 x 15        Plaque Color: Choose a Plaque Color Wood Grain Black Red Light Blue Dark Blue Green Grey Mahogany

     Plaque Orientation: Choose Plaque Orientation Vertical Landscape

    Print Method/Style: Choose Text Type Black Sublimation (Printed with Ink) Color Sublimation (Printed with ink) Engraved (.15 per Letter)

     Plate Material: Choose Plate Material Aluminum Brass         Plate Corner Style: Plain Cut (Notched) Rounded

    Plate Color: Choose Plate Color Bright Gold Brushed Gold White (Sublimation Only) Black (Engraved Plate Only) Other (Specify in Additional Features)

     Plate Size:     Height   x Width

    If Plaque requires more than one plate, specify sizes here: (Optional)

                    Additional Plate Size:     Height   x Width
                    Additional Plate Size:     Height   x Width  

    Back Plate: No Yes      Back Plate Corner Style: None Plain Cut (Notched) Rounded

    Back Plate Color: None Bright Gold Brushed Gold White Black Red Blue Green Other (Specify in Additional Features)

    If Individual Plates are required, how many:

    Additional Features Required on Plaque

        Plaque Text:
                                              
          

    Additional Information or Comments:

After the order is received, we will contact you to verify the order, supply you with the detailed pricing, and to get additional billing information.