Order Form
This form can be dropped off at the Worsley School office, or can be mailed to:
Worsley School
Engraved Plaques
Box 210 Worsley Alberta T0H3W0
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Please enclose a cheque, along with this form, for the total amount of all plaques ordered, made out to Grace Gifts. Expect delivery within 2-4 weeks after your order is received.
Or you can deal directly with Grace Gifts ... contact Fred Glover by email at
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Text Only Plaque:
Your Text: Attach on a separate sheet. Print neatly. If possible, include a clear photocopy of the original. Bible passages may be referenced by book, chapter, and verse(s).
Wood: (circle one) Bass (light) Alder (dark)
Size: (circle one)
4X6 $15.60 5X7 $22.75 6X8 $31.20 7X9 $40.95 8X10 $52.00 9X11 $64.35
Cost (as above) X _____ plaque(s) = $________
One-time set-up fee.............................. $10.00
Shipping and handling ......................... $5.00
Subtotal .................................................... $________
GST (7% of line above) ......................... $________
Total cost .......... $_____________
Photo Plaques
If you are ordering a photo plaque and are enclosing a photograph, make sure it is as clear, well-lit, and as sharp as possible; larger sizes work better. Your photo will be returned with your plaque.
Wood: (circle one) Bass (light) Alder (dark)
Size: (circle one)
4X6 $15.60 5X7 $22.75 6X8 $31.20 7X9 $40.95 8X10 $52.00 9X11 $64.35
Cost (as above) X _____ plaque(s) = $________
Shipping and handling ......................... $5.00
Subtotal .................................................... $________
GST (7% of line above) ......................... $________
Total cost ........... $_____________
Custom Photo Plaque:
Inscription: ______________________________________________________________
Wood: (circle one) Bass (light) Alder (dark)
Size: (circle one)
4X6 $15.60 5X7 $22.75 6X8 $31.20 7X9 $40.95 8X10 $52.00 9X11 $64.35
Cost (as above) X _____ plaque(s) = $________
One-time set-up fee............................... $10.00
Shipping and handling ......................... $5.00
Subtotal ................................................... $________
GST (7% of line above) ........................ $________
Total cost ........... $_____________
Don't forget to enclose your photo!
Receiving Your Plaque:
You may pick up your plaque at the school:
Name: _______________________________ Phone No: _____________(we'll call when it arrives)
Your plaque can also be mailed directly to you; please fill in your address.
Name: ______________________________________
Mailing Address: _____________________________________________________
Postal Code: ______________ Phone Number: ___________________
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