CUSTOM BADGE ORDER FORM


1-10 BADGE ORDER FORM - Custom Badges District 7170

Please fill in all required fields. The fields marked with a * are required for us to properly process your order.

CLUB INFORMATION / BILL TO
* Club Name
District #
* Name
Care of
* Address
* City
* State   * Zip Code  
* Day Phone
Fax
* Email

  SHIP TO - if different
Name
Care of
Address
City
State   Zip Code  
Day Phone
Fax
Email

  BILL TO CLUB..

.. OR PAY BY CREDIT CARD

VISA

MC

AMEX

DISCOVER
Credit Card
Number
Expiration
Date
Cardholder's
Name
BADGE STYLES

RCB10

Custom Badges on Gold Material
 

COST OF BADGES

1 or 2 @ 10.00
3 to 5 @ $9.00
6 to 24 @ $8.00
25+ @ $7.50

FASTENER TYPES

Bulldog Swivel Clip:


No extra charge
Specify A on Order Form

Clip & Pin Combo:


Add $0.75
Specify B on Order Form

Magnet Backing:


Add $1.25
Specify M on Order Form

* ROTARY CLUB NAME

Full Rotary club name exactly as it should appear on your badge

BADGE INFORMATION

Please fill out complete information for each badge ordered. When selecting Style RO-20 or RO-25 please add the Term of Office in the appropriate field.
Badge

Style

 * Fastener
type		 * Nickname or
First Name		 *Last Name * Classification
22 letters max		 Past
President
Term of Office

Please check all spelling and fill out all fields as required, including all information regarding the product(s) you are ordering. Your order cannot be processed if required fields are not filled. Check this box and click the Send Email button when ready.

SPECIAL INSTRUCTIONS

All badges will be sent via first class mail unless otherwise instructed.

 




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