Online Ordering Area

Welcome to our online ordering area.
Please fill out the form in full as it pertains to your order.
If you have any questions please feel free to E-mail us
or give us a call at (800) 347-6163.
Printable Order forms are available for mailing and faxing here.

All Fields in RED are required.
Fields in Green are optional items.

Style#:
PIN#:
Type of Item Ordering:
Quantity:
Base Price

Optional Cost Services
Badge# on Shield Card:
$6.00
Watermark on Shield Card:
$18.00
Custom Printing (SAC)
$ 45.00/25 Sets
$55.00/100 Sets
$95.00/1000 Sets
None
Inscription (Crystal Art)
 $95.00

Please fill out this section as you would like to see it
on your Shield Card product.
Organization Name:
Other, (if not specified above):
Name to be printed on Shield Card:
Title/Rank:
Other, (if not specified above):
Division/Unit:
Misc. Information:
Optional Data:
Street Address:
City, State, & Zip
Area Code/Phone #:
Secondary phone#
Fax Number:
Pager Number:
Cell Phone Number:
E-Mail Address:

PAYMENT SECTION AND AGREEMENT
BETWEEN PURCHASER AND SHIELD CARD AMERICA

This section pertains to your personal payment information.
Purchaser First Name:
Purchaser Last Name:
Purchaser Street Address:
Purchaser Apartment No:
Purchaser City:
Purchaser State:
Purchaser Zip:
Method of Payment:
Card Type:

Card Number:
Expiration Date:
Total Amount of Purchase in U.S. Dollars: $
The issuer of my credit card identified above is authorized to pay Shield Card America the amount shown as Total Amount of Purchase in U.S. Dollars, (above) upon proper presentation thereof. I promise to pay such Total Amount of Purchase in U.S. Dollars amount (together with any other charges due thereon) subject to and in accordance with the agreement governing the use of such credit card. By checking this box I agree with the terms as stated.

E-mail Address (Required):



For shipping information on your order, please visit the SCA Fact Sheet

Copyright Shield Card America, P.O. Box 58 Payson, Utah 84651 www.shieldcardamerica.com