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SCHOOL AFFILIATION _________________________________________  SCHOOL LOCATION - TOWN & STATE ________________________
 
  Sales  Customer’s
 Professional ______________________________ No. __________  Signature _______________________________ Date  __________________________
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DOCTORAL HOOD:  
   
           Doctoral Hood -Black Base Standard with Degree Velvet
            DEGREE:  ________________________________________
  VELVET DEGREE/SUBJECT COLOR: Light Blue 
             SCHOOL: GEORGIA STATE UNIVERSITY
Individual
Street Address 
City                                                           State                            Zip
Daytime Phone                                                       Best Time To Call
Email address
(            )
Individual
Street Address 
City                                   County                            State            Zip
Ofce Phone                                                       Best Time To Call
Email address
DOCTORAL GOWN: 
           Special Executive Doctoral in Education (EDD)Gown for Georgia 
State University Gabardine Black Faculty Gown with Light Blue 
Velvet panels and chevrons. Georgia State University patch in 
Black & White sewn onto each panel chest high. 
GEORGIA STATE UNIVERSITY
ATLANTA, GA
$451.30
DOCTORAL CAP:  
 
           8 SIDED Black Velvet Tam w/Gold Silk Tassel
$157.00
$107.60
Messier and Associates                 0491
Pricing effective until July 1, 2015
Seasonal demands may affect the delivery time on your order.  Please allow 4 - 6 weeks for manufacturing (shipping time 
additional) after the complete order is received in our Champaign Office.
*DATE NEEDED _______________________________ 
*If your date needed is sooner than the 4 - 6 weeks required for manufacturing, you may be contacted at the phone number 
you’ve listed above with information on possible expedited manufacturing/shipping options.
ACCESSORIES:
  REMARKS & SPECIAL INSTRUCTIONS __________________________
_____________________________________________________________
_____________________________________________________________
FAX COMPLETED FORM TO 678-240-9281
To conrm your order, please contact our ofce at 678-240-9283
MEASUREMENTS
(Please Give All Information Requested)
 MALE                 FEMALE
 1.  Height with shoes - top of head to oor ________ feet _______ inches.
 2.  Chest size - without coat _________________inches.
 3.  Shirt sleeve measurement ________________ inches.
  (Measure from center-back of neck, over the top of the shoulder, and along the    
    outer arm to the break at the back of the wrist.)
 4.  Cap size ______________________________inches.
 5.  Floor clearance desired __________________inches.
  (We will provide a 8" clearance if you do not specify.)
 6.   Personalized initials (if desired; no extra charge) - specify: _____ _____ _____
COST SUMMARY OF ORDER
Gown ..................................................................................$   __________
Hood .....................................................................................    __________ 
Cap/Tam ...............................................................................    __________
Tassel ...................................................................................    __________
Other Items:   __________   .................................................    __________
   __________   .................................................    __________
  Cost of merchandise ........................................................   __________
 
  SALES TAX - your local rate ............................................    __________
  SHIPPING & HANDLING ...............................................$   __________
    Ground Service (to U.S. 48) $19.95
    Call for Air Freight Charges or if outside U.S. 48
  TOTAL COST OF ORDER .............................................$   __________
 
  BALANCE DUE   ...........................................................$   __________
CREDIT CARD OR PURCHASE ORDER
  VISA       Mastercard       Discover
Credit Card No. ______________________________________________
Expiration Date ______________________________________________
Name on Card _______________________________________________
Name exactly as it appears on card
Purchase Order # ____________________________________________
GARMENT BAGS:      E-Z Stor Garment Bag $10.40 
     Nylon Garment Bag $31.70 
     Carry-All Garment Bag $74.95 
HANGERS:       Black Contoured Hanger $2.55 
      Black Conformer 1 3/4" deep hanger $7.80 
PROMO GSUEDD100 (3/1/15 - 3/15/15) -$100.00
Please print legibly  
 
                  Herff Jones Order No.
                 Customer No.                                 Customer No.
SPECIAL APPAREL ORDER FORM