12
x 6 x 3/8 Sandblast Etched Black Granite, no fill (L) White/Gray Marble, black
fill (R)
Suitable for outdoor use
(Frame not
included)
Name
__________________________________
Date ____________________
Address __________________________________________________________
City, State, Zip _____________________________________________________
Phone ___________________ Email
(never distributed)
________________________
__
__
__
__
Check __
Money Order
CC# _________ _________
_________ _________ Exp Date
_________
Credit Card Billing Address (if
different) ___________________________________
__
White/Gray Marble $ 49.95
__
Black Granite $ 54.95 __ Gold fill (Black Only)
Font
Style for Name (Please circle one)
Name to be
engraved _____________________________________Paw Prints? _____
Years
_______________________________________
Please
allow 2-3 weeks to complete, credit cards will not be billed until completed.
Maine residences, add 5% sales tax.
Available for pick-up in Saco, ME or
shipped anywhere in the U.S. for an additional $10
Mail
or Fax this form to (207) 929-5117
Distinct Impressions
P O Box 429 Bar Mills, ME 04004-0429
Tel (207) 929-5116 (800) 662-2845
www.distinctimpressions.com