Fine Quality Custom Academic Regalia-A La Carte
Order Form-DEADLINE FOR ORDERING MARCH 31, 2017
TODAY'S DATE:
Order Form effective through June 30th, 2017
Jostens Representative #:
CONSUMER (FULL PAYMENT REQUIRED)
Ship to:
BOOKSTORE
SCHOOL
CUSTOMER #:
Please allow 5 weeks for delivery
Consumer Information
Name:
Address:
City,State, Zip:
Telephone # Daytime:
Email Address:
Comp rental
needed by:
1-Apr
DATE WANTED:
Bookstore Name:
School:
School Address:
City, State, Zip:
Telephone:
Contact Person:
MEASUREMENTS - SEE MEASURING GUIDELINES
1) Height:
Ft.
In.
2) Weight:
Lbs.
3) Shoulder to Shoulder:
In.
5) Sleeve Length:
In.
4) Chest Size:
In.
6) Head Size:
In.
DEGREE
PhD Royal Blue
Exact Wording:
Institution from which your degree was awarded (do not abbreviate)
City:
State
NOTE: PhD will receive royal blue velvet on the hood unless otherwise specified
QTY
ITEM
PRICE
ENTER PRICE ITEM
QTY
BACHELOR/MASTER SELECTIONS
ALL DEGREES - BLACK GOWN & HOOD MATERIAL SELECTION
Black Revive Recycled Polyester*
Black Elegance Peachskin
Black Imperial Poly Cotton
Black Prestige Crepe
Black Brilliance Sand Crepe (Chromspun)
Black Radiance Satin
Black Majestic Poplin
Other
ENTER
PRICE
PRICE
Bachelor Gown
Bachelor Hood
0 $251.00
0 $98.50
$0.00
$0.00
Master Gown
Master Hood
0 $272.50
0 $106.50
$0.00
$0.00
Deluxe Quilted Mortarboard Cap No Tassel
Tassel color (degree color will match hood velvet color)
0
0
$51.00
$4.00
$0.00
$0.00
Fourth Chevron, pair
$35.00
$0.00
*DEFAULT FABRIC
DOCTOR SELECTIONS
Sussex Doctoral Gown
Windsor Doctoral Gown
Gown Velvet Color
Black
0
0
Royal
$516.50
$726.00
$0.00
$0.00
Other
Black
OTHER
Piping
President's Regalia
Official Regalia
Y
N
Y
N
Other
Degree Color
Black
Degree Color
NOTES
Doctoral Hood
Classic Tam
Deluxe Tam
Classic Pieced Tam
Deluxe Pieced Tam
Tam number of sides
Premier Tam, 8 sided
Tam Velvet Color
Black
Royal
6
4
$129.50
$0.00
0
0
0
0
8 (Check One)
$63.00
$72.50
$80.00
$88.00
$0.00
$0.00
$0.00
$0.00
$70.00
$0.00
0
0
$22.50
$58.00
$0.00
$0.00
0
0
0
$16.00
$11.50
$15.50
$0.00
$0.00
$0.00
$7.00
$7.00
$7.00
$0.00
$0.00
$0.00
Silver Bullion
Premium Velvet Upgrade, Gown
Premium Velvet Upgrade, Hood
Premium Velvet Upgrade, Tam
Order is subject to acceptance by Jostens. 50% of payment is nonrefundable if order cancelled after 5
days or comp rental provided. NO RETURNS. Certain alterations free of charge for up to 30 days
after receipt of product (customer is responsible for delivery of product to Jostens and shipping
charges). Please see tab Measuring Guidelines for more details about Alterations.
$0.00
$0.00
Subtotal Gown, Hood and Cap/Tam
Subtotal Upgrades if applicable
Domestic Shipping (USA)
Other
Gold Silky Tassel
Metallic Bullion Tassel
Gold Bullion
0
International Shipping
Subtotal
State Tax
Total
Less Payment
Balance Due
CREDIT CARD PROCESSED BY:
$19.95
$99.99
Tax rate
$
$0.00
$
$
$
BOOKSTORE
-
JOSTENS
UPGRADES FOR ALL DEGREES
Embroidered Initials on Gown __ __ __ __
Embroidered Initials on Hood __ __ __ __
Embroidered Initials on Tam
__ __ __ __
Amount Charged:
Signature
Write Credit Card Number Below*
Pockets (pocket left / access right)
Pocket
Left
Right
Access
Left
Right
0
0
0
$20.00
$13.00 Each
$7.00 Each
$0.00
$0.00
$0.00
Garment Bag & Wooden Hanger
0
$50.00
$0.00
Credit Card #
Exp. Date
Card Holder's Name (print name):
*DO NOT EMAIL CREDIT CARD NUMBERS - PLEASE FAX TO 800-655-5725
This is a customized product. Cardholder understands payment(s) may be charged before goods are delivered.