Please print this form and use it to Mail or call in your order.
Billing Address:
Name : _______________________________________ Day Phone: __________________________

Street : _______________________________________ Email : ______________________________

City : __________________________________________ State: ________ Zip:__________________
 
Shipping Address: if needed
Name : _______________________________________ Day Phone: __________________________

Street : _______________________________________ Email : ______________________________

City : __________________________________________ State: _________ Zip:_________________

Item Code

Description

Quantity

Price Each

Total
      $ $
      $ $
      $ $
      $ $
      $ $
      $ $
      $ $

LAPEL PIN:
Available for a $7.00 donation which includes shipping and handling.

4 INCH PATCH:
Available for a $25.00 donation which includes shipping and handling.

 Merchandise Total. . . . . . . . . . . . . . . $
Shipping & Handling. . . . . . . . . . . . . . $ Included
Subtotal  . . . . . . . . . . . . . . . . . . . . . . . $
Total Amount Enclosed. . . . . . . . . . . . . $
Payment Method

Payment Method :

Personal Check _______   Money Order _______

 
Office Use Only:

 Date: ______________________

 Invoice: ____________________

Make Checks or Money Orders Payable to:
Holy Trinity Anglican Church
P.O. Box 50294
Jacksonville Beach, FL 32240-0294
Phone: (904) 247-1442