Statuette Order Form |

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Fields marked with an * are required.

Date *

First Name *

Last Name *

Email *

Telephone *

Complete this section for addresses in the United States

Street Address

City

Zip / Post Code

Complete this section for international addresses

International Address

Country *

Film Name(s) *

********** INSTRUCTIONS **********

Line #1 - Will be "Accolade Winner" (Completed by Accolade staff)

Line #2 - Your level of award (Award of Merit, Award of Excellence, or Award of Recognition) (Completed by Accolade staff)

In addition to Line #1 and Line #2 you have another six (6) lines to use.

You do NOT need to use all six lines.

NO MORE than 24 characters (including spaces) per line.

***************************

Statuette # 1

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #2

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #3

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #4

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #5

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #6

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #7

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Statuette #8

Line #1

Line #2

Line #3

Line #4

Line #5

Line #6

Line #7

Line #8

Special Instructions

Order Totals

Sub Total

Sales Tax: Purchases made within the State of California must include 9% sales tax. If you are not making your purchase within the State of California, USA please put a 0 here. *

Total

When you click the "submit" button - you will be taken to the secure PayPal website for payment.

You can pay with a PayPal account or a credit card.

When your transaction is complete - you will automatically be brought back to this page.