Brass Letter Opener Fellowship Plaque Lapel Pin Attachments

Brass
Letter Opener
Portfolio
$25
5 x 7 Brass
Picture Frame
$30
Note Cards
Business Card Holder
$25
$30
$30
Crystal Award
Mug
$75
Crystal Paperweight
$15
$75
ACD Test without Frame
$15
Fellowship Plaque
$75
Rosette
$15
Attachments
15-Year $10
25-Year $15
Lapel Pin
ACD Scarf
10k $120
14k $150
$25
Women’s Lilac or White
Polo with ACD Text
$50
ACD Tie
Cufflinks
$40
$55
Men’s Navy/Light Blue, Burgundy/Black,
and Steel Grey/Black Silk Touch Polo
with ACD Text
$55
Men’s Navy/Winter White Silk Touch
Polo with ACD Text
$55
Attachment (15-Year)
Attachment (25-Year)
Business Card Holder
Crystal Award
Crystal Paperweight
Cufflinks Fellowship Certificate Plaque
Fellowship Pin (10k)
Fellowship Pin (14k)
Letter Opener (Brass)
$30
$150
$120
$75
$55
$75
$75
$30
$15
$10
$15
Price
Total
Portfolio (Durahyde) $25
$30
Men’s Burgundy/Black Silk Touch Polo with ACD Text
Men’s Steel Grey/Black Silk Touch Polo with ACD Text
Note Cards with Envelopes (10)
ACD Scarf
ACD Tie
Women’s Lilac Polo with ACD Text
$50
$40
$25
$25
$55
$55
$55
$55
Women’s White Polo with ACD Text $50
Subtotal
Shirts available in S, M, L, XL, XXL
$5 Shipping & Handling
All Polo Shirts are made by Port Authority.
6% Sales Tax (MD only)
See instructions on the right for additional information.
TOTAL
Prices subject to change without notice.
2013
Men’s Navy/Light Blue Silk Touch Polo with ACD Text
Men’s Navy/Winter White Silk Touch Polo with ACD Text
Rosette $15
Picture Frame (5 x 7 Brass)
Mug $15
ACD Test for Ethical Decisions without Frame
Size
QtyItem Description
Order Form
The Gallery
American College of Dentists
(U.S. Dollars)
Check or Money Order
of purchase for an exchange or refund of the purchase price.
The American College of Dentists will replace any defective articles returned within 30 days
Gaithersburg Office. Shipping outside of the U.S. may be more depending on the destination.
handling. A $5 shipping and handling charge will be added to all other items shipped from the
P.O. boxes. Prices for the Fellowship Plaque, Rosette, and Attachments include shipping and
The American College of Dentists ships via United Parcel Service to U.S. destinations only. No
must be in U.S. funds only.
The American College of Dentists accepts MasterCard or VISA. Checks and money orders
Gaithersburg, MD 20878-1614
839J Quince Orchard Boulevard
American College of Dentists
with payment by credit card, check or money order to:
Please complete this form and either fax your credit card order to 301-977-3330 or mail your order
Expiration Date:______________________________________________________________
Signature:__________________________________________________________________
Card #: ____________________________________________________________________
Method of Payment:
Year Inducted (for Plaque):_____________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Personalization (for Plaque or Crystal Award):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Ship to (if different from above):
Phone: ____________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Ordered by: _________________________________________________________________