Plaque Order Form

(This form may be downloaded and/or copied and pasted into a Word file for filling out)

                                                          MILESTONE PLAQUE ORDER FORM

(NOTE: THE MILESTONE PROPOSAL MUST HAVE PASSED THROUGH THE ENTIRE APPROVAL PROCESS AND OBTAINED FINAL BOARD OF DIRECTORS APPROVAL BEFORE PLAQUE(S) MAY BE ORDERED.)

PLAQUES REQUIRE 10-12 WEEKS TO CAST AND SHIP. THIS TIME CANNOT BE SHORTENED. It is your responsibility to allow enough time between placing the order and submitting payment to the History Center, and the dedication ceremony for the plaques to arrive on time. If you are ordering more than 3-4 plaques, it is recommended to allow even more time.

The month and year of the dedication are cast on the plaque(s). Thus the date of the dedication must be decided prior to the ordering of the plaques.

Please email this filled-out form to: r.colburn@ieee.org, Milestones Administrator, IEEE History Center, 445 Hoes Lane, Piscataway, NJ 08854, USA, +1 732 562 5468. Please include the docket number of your milestone in the subject line of the email. (For a printer-friendly version, click on "Printable Version" under "Tools" in the grey box to the left.)

History Center staff will send you an invoice with the payment options and instructions. Do not initiate payment until you have received the invoice and the payment instructions.

Plaques cost US$937 per plaque plus shipping. Current shipping costs per plaque are:
Within U.S.A.: $63; to Canada: $42, to Europe: $495,  India: $495, Asia and Pacific: $495. Other destinations might vary. IEEE History Center staff can supply costs to you on request. There is no discount in cost for multiple plaques.

Customs duties, VAT, and other taxes and fees are the responsibility of the sponsoring organizational unit (recipient), and might be an additional cost.

Plaques may be paid for by three methods: Check, credit card (Visa or Mastercard), wire transfer, or transfer to IEEE History Center account from IEEE organizational unit account. (Deduction from Section rebate is not a payment option.) IEEE History Center staff will provide payment details (e.g how to arrange transfer to History Center account) on the invoice that will be sent to the IEEE organizational unit. For details, see Plaque payment options Payment must be made by an IEEE organizational unit to the History Center. The History Center cannot invoice a non-IEEE entity, and cannot receive payment from a non-IEEE entity. In cases where a corporation or non-IEEE sponsor has agreed to support the cost of the plaque, the IEEE sponsoring organizational unit must pay the History Center and then obtain reimbursement from the non-IEEE sponsor. (The only exception to this requirement is when the customs regulations of the receiving country make it easier or more cost-effective for the payment to come directly from an entity in that country. Permission must be obtained in advance from History Center staff in such cases.)

GST, VAT, or other customs duties (if applicable) are the responsibility of the ordering organizational unit and must be paid separately between the OU and the appropriate customs service.

Name of Milestone: ________________________________________

Docket Number of Milestone: ________________________________ (Example: 2014-02. Docket numbers can be found on the Milestones Status Report) at http://ieeemilestones.ethw.org/Milestones_Status_Report

Date of Milestone dedication ceremony: Day ________Month __________Year ________

Number of plaques: _______________________________________

If there will be versions of the plaque in other languages, the translation must be made—or validated by—a third-party professional translator at the sponsoring organizational unit(s)’ expense. please list the name and email of the person who will supply the translation(s):

Translator’s name: ___________________________________

Translator’s email: ___________________________________

If the above is not a professional translator, provide name and email of professional who verified the translation:

Name: __________________________

Email: __________________________

Name and street address of person to ship plaque(s) to (FedEx and UPS cannot deliver to post office boxes):

Name:______________________________

Address:_____________________________

______________________________

_______________________________

Telephone number of person to ship plaque(s) to (necessary for FedEx or UPS label in case of problems with customs or delivery):___________________________

Email address of person to ship plaques to: _____________________________ (so that IEEE History Center staff can email them the tracking numbers)

GST, VAT or other number (if applicable): ______________________________________________

Are there any shipping or customs details of which we should be aware? _________________
____________________________________________________________________________

Name and email address of the person to invoice for the plaques. This must be the Treasurer or authorized financial officer of the sponsoring IEEE organizational unit. The invoice must be sent to the treasurer or authorized financial officer of an IEEE organizational unit because the IEEE History Center may not invoice non-IEEE sponsor(s). In cases where a corporation or other non-IEEE organization has agreed to sponsor the cost of the plaque(s), it will be the IEEE organizational unit’s responsibility to pay the History Center and to obtain reimbursement from the non-IEEE sponsor.

Name: _________________________________________

IEEE Title: ______________________________________

Email:__________________________________________

Section Chair Name: _________________________________

Section Chair email: ________________________________

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