Commissioning Keepsake Order Form

Dimensions of Frame: 5.5" x 8.8" - (Attractive Gold Painted Wood)

Holds a 2.5" x 3.5 " Wallet sized Photo

Cost: $25 (includes shipping & handling and engraving)

Name of purchaser: _____________________________________________

Shipping Address: _____________________________________________

___________________________ Zip ______________

Email address: ___________________________________

Initials to be engraved Date to be engraved on 2^nd Lt Bar: _______________

Graduation Date to be engraved on 2^nd Lt Bar: _______________

Quantity ordered: ____________

Amount of check enclosed @$25 each ________________

Please make checks payable to: USAFA Cadet Parents of E. MA

Send order, check, and Wallet Sized picture to:

Frank Puccia

14 Brookfield Lane

Saugus, MA 01906

Email: frank.puccia@verizon.net