Please Print and Mail this form to:

Rhonda Borden, Dog Supt.
1412 Bailey Road
Elma, WA 98541

Name
Address
Phone
Plate Size
(1" x 3" , 3' x 5" , 5" x 5" )
Plate Color (Blue, Red, Silver, Black)

What you would like engraved on your plate:

Line 1 20 letters per line (spaces don't count)
Line 2 (3x5 and 5x5 plates only)