Lucite Package Order Form

Simply fill out the highlighted areas
and submit the order to your local authorized Blackinton dealer
along with your badge, or order a badge separately!
V.H. Blackinton does not accept orders directly!
Your order must be processed through an authorized Blackinton Distributor!
Blackinton guarantees the quality of your Lucite when using a Blackinton badge.
Lucite will ship four weeks from receipt of a purchase order when the badge is provided.
If the badge has been ordered separately, delivery is seven to eight weeks.
Your Lucite comes with a colored background, rubber cabachons on its base for protection,
and the option of a personalized engraved plate that fits up to three lines of text!
Please note, slight variations and imperfections may occur on any Lucite embedment. These can result from chemical reactions, numerous
hand finishing steps, and other complexities involved in creating your one-of-a-kind memento.
Fill in your contact information and specify which Lucite you are ordering:
(Print clearly and place an 'X' in the box of the option you are purchasing)
Department:
Phone:
Contact:
Email:
Option A
1 Badge
NO Nameplate
(LUC-233-PK1)
Option B
1 Badge
with Nameplate
(LUC-239-PK2)
Option C
2 Badges
with Nameplate
(LUC-216-PK3)
Option D
3 Badges
with Nameplate
(LUC-234-PK4)
Option E
4 or 5 Badges
with Nameplate
(LUC-226-PK5)
Retail Price:
2 7/8” wide by 3 3/4” high by 1 1/8” at the base by 5/8" at
the top. Personalized name plate not included.
Rubber Cabachons on base.
$47.25
(+ Shipping/Handling)
Retail Price:
3 1/2” wide by 5” high by 1 3/4” at the base by 5/8" at the
top. Includes nameplate (A4566) with up to 3 lines of
custom text. Rubber Cabachons on base.
$102.85
(+ Shipping/Handling)
Retail Price:
4 1/4" high by 6 1/4" wide by 1 3/4" at the base by 1 1/4"
at the top. Includes nameplate (A4566) with up to 3
lines of custom text. Rubber Cabachons on base.
$120.00
(+ Shipping/Handling)
Retail Price:
6 1/4" high by 7 1/4" wide by 2 1/2" at the base by 1 5/8"
at the top. Includes nameplate (A4566) with up to 3
lines of custom text. Rubber Cabachons on base.
$233.25
(+ Shipping/Handling)
Retail Price:
8 1/4” wide by 6” high by 2 3/4” at the base by 1 5/8”
thick at the top. Includes nameplate (A4566) with up to
3 lines of custom text. Rubber Cabachons on base.
Choose the color of the background:
Red (175)
Blue (509)
Green (100)
Black (706)
$260.20
(+ Shipping/Handling)
Specify text for up to THREE lines of engraving (Options B, C, D, & E ONLY):
(Please PRINT clearly. Text will be centered on plate. All receive black lettering in a block font.)
Choose the finish of the engraved plate:
Gold
Silver
If plate finish is not specified, silver badges will receive a silver plate, gold and two tone badges a gold plate. If no background color selected, default will be
clear.
(Dealer Use Only) Billing & Shipping - Fax Order to VHB (800) 695-5349 or include with badge supplied by customer.
Store
Acct#:
Store Name:
Contact:
Shipping address if order is being drop shipped:
Ship to:
PO#:
Date:
Details of related badge order (if applicable):
(Please reference the above Lucite PO# in the special instructions of the badge order)
Badge
PO#:
Badge
Style:
Date:
Special
Instructions:
Attn:
V.01.4.2015
Pricing on this form expires 12/31/2015

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