Patent Plaque Order Form

Once you have filled out the order form below, please print it out and either fax or mail the order form to us for processing. The fax number and mailing address is located at the bottom of this order form.

If you are ordering plaques for several different patent numbers in exactly the same style and board, you can enter the patent numbers in the notes section below rather than completing a form for each patent number.

Patent Number

Style A:		Qty	Price	Total
	Solid walnut board with pewtertone plate		$70.00
	Solid walnut board with goldtone plate		$75.00

Style B:		Qty	Price	Total
	Solid walnut board with pewtertone plate		$90.00
	Solid walnut board with goldtone plate		$95.00

enter inventor's name to appear on plaque

Style C:		Qty	Price	Total
	Pewtertone plate on black acrylic, silver frame		$115.00

enter inventor's name to appear on plaque

Style D:		Qty	Price	Total
	Solid walnut board with pewtertone plate		$80.00
	Solid walnut board with goldtone plate		$85.00

Style E:		Qty	Price	Total
	Solid walnut board with pewtertone plate		$80.00
	Solid walnut board with goldtone plate		$85.00

enter inventor's name to appear on plaque

Style Marble 1:		Qty	Price	Total
	Marble Plaque, 8" x 12" x 1"		$110.00

Desk Accessories:		Qty	Price	Total
	Paperweight		$30.00
	Pen and Pencil Set		$50.00
	Pen and Notepad Set		$70.00

Shipping:		Qty	Price	Total
	First plaque (UPS ground service)	1	$14.00
	Each additional plaque (UPS ground service)		$6.50

SALES TAX: 6.25% Massachusetts sales tax (Massachusetts residents and companies).

A signature and date is required to process all orders. In the box below, please type your name then sign and date next to the typed name.




To order by credit card, click here.

Ordering Instructions

Patent Plaques and Prices

Send us email at patentinfo@memco.net