Date:　 ※Please fill out all items below. Request from □ Individual □ Company or Organization Name Zip   Address Phone 　　　　　　　　　　　　- FAX 　　　　　　　　　　　　- Company/Organization Name Department Occupation Email 　　　　　　　　　　　　　＠ Lapel Pin Type (Choose one) □ Etched □ Silk Screened □ Offset Printing □ Stamped □ Two-Dimensional Soft PVC Size Length　　　　　　　mm / inch Width　　　　　　　mm / inch Number of Colors □4 　□3 　□2 　□1　 □No Color　 □5 or more Fastenings □ Butterfly Clutch □ Screw Back □ Safety Pin Attachment □ Tie Tac Clutch □ Stick Pin 　 Quantity Artwork □ I am sending camera-ready copy 　　□ Please do the artwork for me I would like a pre-production sample: □ Yes 　　□ No Date needed by 　　　　　　Month 　　　　　　Day 　　　　　　Year Comments