Copy of Mark Awards Order Form

Use one form per statue and/or certificate order.

Statues

	Subtotal
Gold: $250.00
Silver: $225.00
Bronze: $200.00
Shipping Charge per Statue Outside of U.S. and Canada: Add $50.00

Certificates

	Subtotal
Gold: $25.00
Silver: $25.00

* Total

Engraving Instructions

Personalization is limited to three lines: Recipient name, winning entry title and company.
Maximum 40 characters per line. (This includes spaces.)
Use upper and lower cases exactly as you want the engraving to appear.

Statue Engraving

Recipient Name:

* Winning Entry Title:

Company:

Certificate Engraving

Recipient Name:

Winning Entry Title:

Company:

Send to:

* Recipient Name:

* Title:

* Company:

* Address:

* City:

* State:

* Zip:

* Country:

* Phone:

* Email:

* Form of Payment

Check

AMEX

VISA

Master Card

Cardholder's Name:

* Account or Check Number

Expiration Date:

* Amount

* Signature:

By checking this box, I authorize the above charges to be made to the designated credit card.

Submit this form by either clicking on Submit below,
or print this form and mail or fax it to:
CTAM, Attn: Denise Motlagh
201 N. Union Street, Suite 440
Alexandria, VA 22314
703.837.6557 (phone)
703.684.1167 (fax)

Please allow 4-6 weeks for delivery in the US and 5-7 weeks for deliveries outside the US.
Confirm your order by emailing denise@ctam.com

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