***********DUPLICATE AWARDS********************************************************************** Please fill out this form completely. Check or credit card information must accompany this order form. Duplicate awards and/or certificates may be ordered through PROMAX only. ORDERING INSTRUCTIONS: Please check one of the following: member/non-member quantity amount Gold Award S$540/S$706 X ________ = ______ Silver Award S$540/S$706 X ________ = ______ Gold Award Certificate S$100/S$142 X ________ = ______ Silver Award Certificate S$100/S$142 X ________ = ______ Event Presented: Year Presented ______ Africa Asia Australia/NZ China India Indonesia _______________________________________________________________________________ Awarded to (Organization Only) _______________________________________________________________________________ Title of Entry _______________________________________________________________________________ Category Title _______________________________________________________________________________ Personal Recognition Duplicate copies of PROMAX Awards or Certificates can only be ordered by those individuals or organizations included in the credits of the winning entries. Please indicate personal credit on the "Personal Recognition" line provided above. SHIPPING INSTRUCTIONS:* _______________________________________________________________________________ Name Member # _______________________________________________________________________________ Title/Position _______________________________________________________________________________ Company (radio and tv stations, please give FCC call letters) _______________________________________________________________________________ Address (No P.O. boxes. Street address only, please) _______________________________________ _____________________________________ City State/Province _______________________________________ ______________________________________ Zip/Postal Code Country _______________________________________ ______________________________________ Telephone Fax _____________________________________________________________________________ E-mail ALL PRICES IN SINGAPORE DOLLARS. INVOICE AVAILABLE UPON REQUEST. Check #__________________________ MC Visa Amex _______________________________________________ _____________ _____________ Card Number CVV Number Exp. Date _____________________________________________________ Signature SGD check should be crossed and made payable to PROMAX ASIA PTE LTD. * Please allow 4-6 weeks for delivery. AWARD SHIPPING & HANDLING COST (per Award - no charge for certificates) Gold/Silver Shipping Domestic (Singapore) add S$38.00 per piece Gold/Silver Shipping Asia Pacific add S$121.00 per piece Gold/Silver Shipping Europe add S$146.00 per piece Gold/Silver Shipping Middle East/South Africa add S$316.00 per piece No shipping charge for certificate. Invoice available upon request. SUBTOTAL $__________ SHIPPING & HANDLING $__________ TOTAL AMOUNT ENCLOSED $__________ CUSTOMS CHARGES, IF ANY, ARE PAID BY THE RECIPIENT DUE TO CUSTOM LETTERING ON AWARDS, PAYMENT MUST ACCOMPANY THIS ORDER. PLEASE NOTE THAT A 7% GST WILL BE ADDED TO ALL ABOVE MENTIONED PRICING. THIS IS APPLICABLE FOR SINGAPORE INDIVIDUAL, COMPANIES AND DELIVERY WITHIN SINGAPORE Mail or fax to: PROMAX ASIA PTE LTD 3C Tank Road Singapore 238060 Tel: 65-6736-1435 Fax: 65-6735-4048 .