THE DALTON PEN - AWARD ORDER FORM

If you are unable to use the online system, please print out this form and fax in the following form to: 650-745-2689

Date: _______________

Circle your request (use one form for each request):

FOR AWARD OF EXCELLENCE AND AWARD OF MERIT WINNERS ONLY

Original Trophy - (one original trophy per winning entry — there is NO FEE for your original trophy)

Duplicate Trophy

FOR AWARD OF HONOR WINNERS ONLY

Note: Award of Honor winners have the option to order duplicate trophies as well as certificates.

Original Certificate - (one original certificate per winning entry — there is NO FEE for your original certificate)

Duplicate Certificate

Duplicate Trophy

Fee for this duplicates (see Duplicate award fees): ___________

Winning Entry ID (see award announcement letter): _________

INFORMATION TO APPEAR ON AWARD

You must print clearly – Warwick Publishing is not responsible for illegible writing and will not replace awards with typos.

Type of Award – Excellence, Merit or Honor

Name to Appear on Award: ______________________________

Winning Entry Title: ____________________________________

Category: ____________________________________________

SHIPPING INFORMATION

(No P.O. Boxes)

Name to Ship to: _______________________________________________

Address: ______________________________________________________

City: ________________________________ State or Province: __________

Country: _____________________________ ZIP Code: ________________

You must also print out and fax payment form for duplicate awards.

Please print out this form and fax to: 650-745-2689