SHAEFFER DESIGN GROUP

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					SHAEFFER DESIGN GROUP
2725 13th Street NW • Washington DC 20009 Phone: 202-256-6015 • Fax: 202-588-0463
( ) Yes, I would like to order a floral arrangement to honor the following officer: Officer’s Name: _____________________________________________________________________ Department: ________________________________________________________________________ End of Watch Date: __________________________________________________________________ Location on the Memorial Wall: Panel ___________Line ____________
SELECT FROM THE FOLLOWING:

( )

Large Traditional Wreath on Tripod (available for $125 or more) ( ) Silk Flowers* ( ) Fresh Flowers Size of wreath: ( ) $125 ( ) $150 ( ) $175 Small Traditional Wreath on Tripod (available for $75 or more) ( ) Silk Flowers * ( ) Fresh Flowers Size of Wreath: ( ) $75 ( ) $85 ( ) $100

Other $_______

( )

Other $ _______

ORDERED BY:

Name/Department: ___________________________________________________________________ Address: ___________________________________________________________________________ City:______________________________________ State:____________ Zip Code:_______________ Telephone: _________________________________ Fax: ____________________________________
METHOD OF PAYMENT: *Required fields

*Card Account Name: ________________________________________________________________
*Card Address: ______________________________________________________________________ *Card City: ________________________________* State: ___________* Zip Code: ______________ *Card Type: ( ) Visa ( ) MasterCard ( ) American Express ( ) Discover ( ) Debit Card

*Card Number: ______________________________________________________________________ *Card Expiration Date: ________________________________________________________________ *Card 3 Digit Security Code ________________________ Amex 4 digits: _______________________ *Signature: ___________________________________________________ ( ) Check or Money Order enclosed
TO ORDER:

By Fax: By Mail:

You can fax your order to Shaeffer Design Group at: 202-588-0463 You can mail your check or money order to: Shaeffer Design Group 2725 13th Street NW Washington, DC 20009
PRICE OF THE SELECTED ITEM: DELIVERY COST: TOTAL COST: $____________ $____________ $____________

*Due to the excessive weather conditions in Washington DC, the Shaeffer Design Group strongly recommends silk flowers, which will last for several weeks.


				
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posted:11/29/2009
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