AMERICAN CHROME SHOVEL COMPANY
Chrome Shovel RETAIL Order Form

Directions:  Please print this form and fax it to the dealer nearest you. Click here for a list of dealers.
When finished click here to return to the American Chrome Shovel web site.

Dealer Name: __________________________________________

Your Name:   __________________________________________

Company:     __________________________________________

SHIP TO ADDRESS:
___________________________________________________

City:_____________________ State:____ Zip:_________

BILL TO ADDRESS (if different than above):
___________________________________________________

City:_____________________ State:____ Zip:_________

Phone: __________________________________

Fax:   __________________________________

Other Comments / Shipping Instructions:

ORDER INFORMATION:

Date Needed: ________________

____ "Show Chrome" plated ceremonial shovel(s)

____ Gold plated ceremonial shovel(s)

____ Engraved plate, 1 1/2" wide x 4" long
     (write engraving type below, limit four lines)
             __________________________________
             __________________________________
             __________________________________
             __________________________________

If you are ordering more than one shovel with different 
engravings, please fax additional pages or order forms.