Dejay Products (aka Dejaygold)

ORDER FORM               
To order plaques please provide all information and email to:

dejaygold@dejaygold.com

Name………………………………………..Company……………………

 

Address………………………………………………………………………

 

……………………………………………………………………………….

 

Tel #…………………………..Email………………………………………

 

Shipping address if different from above………………………………..

 

………………………………………………………………………………

 

Artist…………………………………….Title…………………………….

 

Name of Recipient(s)………………………………………………………

……………………………………………………………………………..

(if more than two please provide separate list)

 

Plaque size; 12x16 14x18 16x20 18x24 20x24 24x36  Other……………

 

Design # ……………………. Status (Gold/Platinum/Multi)………….

……………………………………………………………………………..

For RIAA Certified awards state your connection to the project:

……………………………………………………………………….

 

Credit card #…………………………………………….

 

Expiration Date……………..  Security Code…………………….

 

Billing address of card……………………………………………...

……………………………………………………………………….
Please note additional charges will include CD ($23) and shipping
An Estimate will be sent upon receipt of this Order Form

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