order form

Click Here To order a OFFICIAL FDNY COMMEMORATIVE AX (Limited Edition of 1,500)

Liberty Art Works, Inc. ORDER FORM

INSTRUCTIONS
1. Complete order form
2. Print out
3. Mail with check or money order to the address listed at the bottom of the page
ONLY Credit Card & Fire Department Purchase Orders may be faxed to 1-636-433-2888


ORDER PRODUCTS

Item	Product #/Price	Quantity	Price	Shipping PER ITEM
1
2
3

		Subtotal
	TOTAL U.S. Shipping		*RUSH ORDERS—Please Call*
	GRAND TOTAL

SECTION A: BRASS PLATE ENGRAVING (3 lines of engraving at 21 spaces per line)
Products 002A-007, 008A, 009, 020A, 020B, 022E, 025, 027A, 027B, 040-042, 042B-045, 050

Line 1 Line 2 Line 3

I do Not want an inlaid brass plate on the ax handle. (For products 006A, 007, 008A & 009)

SECTION B: EXTRA ENGRAVING AX BLADE/PLATE Product 029 (2 lines of engraving at 21 spaces per line)

Line 1 Line 2

SECTION C: CHOOSE ONE SHIELD Products 040 & 041 (Choose one shield)

Chief Assistant Chief Deputy Chief Battalion Chief Captain Lieutenant Medical Officer

Firefighter Engineer Firefighter Paramedic Firefighter EMT IAFF

SECTION D: RIBBON ENGRAVING Products 008, 019A & 019B (12 spaces each for upper & lower ribbon only)

Upper Ribbon Lower Ribbon

PAYMENT OPTIONS

CHECK DEPT. PURCHASE ORDERMONEY ORDER

Name on Card

Card Number Expiration

Billing Address

SHIPPING TO

NamePhone

Department

IAFF Local No. FOP Lodge No.

(Required for all IAFF and FOP products. Order may be subject to verification of membership.)

Address

City, State, Zip

*RETURNS & REFUNDS NOT ACCEPTED AFTER 30 DAYS*

*RETURNS ARE SUBJECT TO A RESTOCKING FEE*

*PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE*

Liberty Art Works, Inc. P.O. Box 38 Dutzow, MO 63342
Phone 1-888-411-7744 Fax 1-636-433-2888