McEver's Awards, Trophies & Gifts

213 Bradley Street - Carrollton, GA 30117

Office: 770-834-0077 - Fax: 770-834-5870

E-mail: mcevers@charter.net

University Of West Georgia Nursing Student

NAME BADGES ORDER FORM

 

Please print name as it will appear on name badge and check the appropriate box titles.

USE FIRST NAME AND LAST NAME

_______________________________________________________________________          ¨ RN   or   ¨ No Title   

*NOTE:  The initials RN will follow the last name for RN-BSN and MSN students

¨ BSN NURSING STUDENT   or   ¨ MSN NURSING STUDENT                                 

Blue with White Lettering Plastic Name Badge(s)

__________   Magnetic Backing Name Badge(s)   X     $9.00 (Taxable)     =    $__________

(Quantity)                                                                                                               

__________   Pin Backing Name Badge(s)            X     $9.00 (Taxable)     =    $__________

(Quantity)                            

__________   Shipping Fee(s) (For 1-3 Badges)     X     $4.00 (Taxable)     =    $__________

(Quantity)               (Mailed via United States Postal Service)

$_________ Total Adding Above 3 Lines + 7% Tax  $__________= Total Due  $__________

(Sub-Total)             (Mailed via United States Postal Service)                        

                              Payment Details – Allow 10 Business Days for Processing Order.

Please make check payable to:         McEver's Awards, Trophies & Gifts

Mail Check & Order Form to:         213 Bradley Street, Carrollton, GA 30117

Or Send Completed Form to:          E-mail:  mcevers@charter.net   Or   Fax: 770-834-5870

Georgia Driver's License # ______________________________________ Expiration Date ________________

Credit Card Type & Number __________________________________________________________________

Expiration Date ______________  Name on Credit Card ____________________________________________

Authorization Signature ______________________________________________________________________

Ship Order To:  Name ___________________________________________ Phone# _____________________

Address __________________________________________________________________________________

City _______________________________________________ State _____________ Zip______