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Personalized Poker Chips Order Form

Choose a Denomination for Each Color of Chips:

Value of White Chips:

Value of Red Chips:

Value of Green Chips:

Value of Blue Chips:

Value of Black Chips:

Value of Purple Chips:

Fill in the box below with desired custom text.

(40 characters MAX per side including spaces)

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip:

*Day Time Phone:

Evening Phone:

*E-mail Address:

Graphic Choice:

Please Choice a Graphic:

****An additional $25.00 will be billed separately for

orders shipping to Hawaii & Alaska

(This additional charge is to cover shipping costs)

Side 1:

Graphic Choice:

Please Choice a Graphic:

Side 2:

Be sure total chips equals 500

VOGRINS PALACE

Custom Poker Chips

This will not complete your order. You will continue on to payment in the next step.

We also accept Personal Checks and Money Orders

Your Total for 500 Custom Poker Chips with Deluxe Aluminum case including shipping will be $224.49