Corporate Bronze Order Form - Bronzing by The Mody Company

CORPORATE BRONZE
ORDER FORM

mail with shoes and payment to:
The Mody Company
56 West Main St.,
Norwich, NY 13815
607-336-6233

Ship To ____________________________________

Street ______________________________________

City ____________________________State _______

Zip ___________ Phone ___________________

payments accepted by check or credit card
Checks payable to Mody Company
Fill in credit card info Below

name on card ___________________________________

card # _________________________________________

exp date _______ 3 digit code ____________

billing address _____________________________

_______________________________________

How to fill in order form

This is a general order form but not applicable for all items. Please call us if you need assistance.
Item number is next to each product or if non show item, write in object
shipping: $12.95 unmounted baby shoes, $15.95 mounted baby shoes & unmounted adult items.
$25.95 per mounted adult shoe & gift item
tax: NY State residents must add 8% sales tax
Mount orders come with FREE name plate, birth stone and zodiac. If there is not much room at page bottom feel free to use back or additional page. Plate engraving is 2 lines, generally name and birthdate (22 characters per line)

	Item # or Object	Mount # and Finish if applicable	Price	Shipping	TOTAL
1	.	.	.		.
2	.	.	.		.
3	.	.	.		.
4	.	.	.		.
				NY residents add 8% tax	.
				TOTAL	.

ENGRAVING INFO (for mount orders only) check if you would like birth stone and/or zodiac

#1
Top Line _________________________________

Bottom Line ______________________________

birth stone _____________ zodiac___________

#3
Top Line _________________________________

Bottom Line ______________________________

birth stone _____________ zodiac ____________

#2
Top Line _________________________________

Bottom Line ______________________________

birth stone _____________ zodiac ____________

#4
Top Line _________________________________

Bottom Line ______________________________

birth stone _____________ zodiac ____________

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