MERCHANDISE ORDER FORM 

BUYER:

NAMEPHONE

STREET

CITYSTATEZIP

EMAIL

ORGANIZATION NAME

SHIP TO BUYER        SHIP TO OTHER ADDRESSEE (FILL-IN BELOW)

NAME

STREET

CITY STATE ZIP

BILL TO:     BUYER    CHAPTER TREASURER    OTHER (PLEASE INDICATE IN COMMENTS BOX BELOW)

MERCHANDISE ITEMS:     USE CATALOG FOR ITEM NUMBER

ITEM NUMBER    QUANTITY    ITEM NUMBER    QUANTITY

ITEM NUMBER    QUANTITY    ITEM NUMBER    QUANTITY

ITEM NUMBER    QUANTITY    ITEM NUMBER    QUANTITY

ITEM NUMBER    QUANTITY    ITEM NUMBER    QUANTITY

ITEM NUMBER    QUANTITY    ITEM NUMBER    QUANTITY

USE BOX BELOW FOR COMMENTS:

YOUR ORDER WILL BE SHIPPED WITHIN 3-5 BUSINESS DAYS UPON RECEIPT OF THE ORDER.   YOUR INVOICE WILL FOLLOW AFTER SHIPMENT HAS BEEN SENT.