Order Form for Podcast Awards Trophies

If you are a 2017 Winner STOP you do not need to fill out this order form unless you want to upgrade your trophy!

2017 Slate Nominees are Allowed To Order
2016 Winners and Nominees are also allowed to Order

 Questions can be directed to ceo@podcastconnect.com

Class Information.

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* 1. Class Information.

Show Name Exactly as you want it on the Trophy

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* 2. Show Name Exactly as you want it on the Trophy

Category you won or where a Nominee

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* 3. Category you won or where a Nominee

Your First and Last Name

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* 4. Your First and Last Name

Street Address

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* 5. Street Address

City

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* 6. City

State

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* 7. State

Zip Code

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* 8. Zip Code

What Size Trophy do you want?

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* 9. What Size Trophy do you want?

Country (Outside US Additional Shipping Charges)

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* 10. Country (Outside US Additional Shipping Charges)

Several Payment Options

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* 11. Several Payment Options

How Many Trophies would you like to Order?

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* 12. How Many Trophies would you like to Order?

Card Number

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* 13. Card Number

Expiration Date  (mm/yy)

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* 14. Expiration Date  (mm/yy)

3 Digit Code on Back of Card

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* 15. 3 Digit Code on Back of Card

Your Digital Signature

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* 16. Your Digital Signature

Billing Address of your Credit Card if different from your Shipping Address

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* 17. Billing Address of your Credit Card if different from your Shipping Address

Your Phone Number

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* 18. Your Phone Number

Your Email Address

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* 19. Your Email Address

Any Questions you may Have?

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* 20. Any Questions you may Have?

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