Purchase order - Alpha Delta Pi



|Badge & Guard Order Form |

|ALPHA DELTA PI EXECUTIVE OFFICE |

|1386 PONCE DE LEON AVE NE |

|ATLANTA, GA 30306 |

|404-378-3164 | PHONE |

|678-510-2162| FAX |

|MEMBER INFORMATION: |SHIP TO: |

|NAME: |RECIPIENT NAME: |

| | |

| | |

|Chapter: |Address: |

| | |

| | |

|School: |City, State, Zip: |

| | |

| | |

| | |

|Badge Engraving: |

|INITIATION DATE: |

| |

|INITIALS (FIRST, MIDDLE, LAST): |

| |

| |

| |

| |Metal Type: | | | |

| |STERLING SILVER (SS) | | | |

| |WHITE GOLD (10KW) |BADGE/GUARD DESCRIPTION: | |TOTAL: |

| |YELLOW GOLD (10KY) | | | |

|BADGE: | | | |

|GUARD: | | |☐ TRADITIONAL | |

| | | |☐ STICKPIN | |

| |SUBTOTAL | |

| |SHIPPING AND HANDLING |$9.00 |

| |TOTAL | |

|Payment INFORMATION: |

| |

|SELECT PAYMENT TYPE: VISA ☐ MASTERCARD ☐ CHECK ENCLOSED ☐ (MADE PAYABLE TO ALPHA DELTA PI) |

|Card Number: #### / #### / #### / #### |

|Card Expiration Date: mm / yy |

| |

|Credit Card Billing Address: (The address where the bill is sent each month.) |

| |

| |

| |

| |

| |

| |

| |

|Name on Card: |

| |

| |

|Email Address: |

| |

| |

|Phone Number: |

| |

| |

| |

| |

|X |

| |

| |

| |

| |

|EMAIL ORDERS TO: Badges@ |

|-OR- |

|MAIL ORDERS TO: 1386 PONCE DE LEON AVE NE |

|ATLANTA, GA 30306 |

-----------------------

[pic]

Note: Badge orders r[pic][?]:;TUfgs{|„ˆ‰Ž?üîßл¨»¨“€k“€Q4“»¨8h+1¤h+1¤B*CJOJPJQJ^J[?]aJmHnHphÿu[pic]2h+1¤B*CJOJPJQJ^J[?]aJmHnHphÿu[pic](h+1¤h?_ü;?B*CJOJQJaJphÿ%h+1¤hJT?B*CJOJQJaJphÿ(h+1¤hJT?;?B*CJOJQJaJphÿ%hí(UhJT?B*CJOJQJaJphÿ(hí(UhJT?;?B*CJOJQJaJequire 4-6 weeks for processing after they are sent from Executive Office to Herff Jones. View additional Herff Jones jewelry options at:



[pic]

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download