Shipping Form

Name: ________________________________
Address: ______________________________
City: ________________ State: _______________ Zip: ___________
Shipping Address: _____________________________________________
City: ________________ State: _______________ Zip: ___________
Tag/License Number: ___________________________________________
County Harvested: ____________ State Harvested: _________________
Date Harvested: _____________ Species: _______________________
Phone Number: (_____) _________________
E-mail Address: ________________________________________________
Description (please include any damage including broken tines, missing teeth, etc.)
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

Please choose from the following (circle one):

1. Whitened and clear coated Yes No
If yes, please choose the finish Matte Finish Gloss Finish

2. Plaque Mount Yes No
If yes, please choose the type Oak Walnut
Please specify if you would like a wall mount or a desk mount in either one of these finishes.


Deposit Amount: $ _____________

Signature: __________________________________ Date:_________________