ALPHA DELTA KAPPA DECEMBER 2010 - Gedung Kuning

Alpha Delta Kappa Official Jewelry, Gifts and Supplies Order Form
Copy this form as needed
Alpha Delta Kappa International Headquarters
(800) 247-2311 • (816) 363-5525 • FAX (816) 363-4010 • headquarters@alphadeltakappa.org
REPLACEMENT BADGES ONLY may be ordered using this form.
(New Member Badges must be ordered on the H-103/131 Membership Application.)
Please Print:
S/P/N* Chapter Name
Name Member ID#
Address Phone
City S/P/N*
Is this a new address? Yes No
INSTRUCTIONS:
Zip or Postal Code
Complete order form. Enclose ONE check for the total amount of the order, including postage and handling.
Make check payable to Alpha Delta Kappa. Payment must be made in U.S. funds. DO NOT send cash
through the mail. Mail to: Alpha Delta Kappa, 1615 West 92nd Street, Kansas City, MO 64114-3210.
CREDIT CARD PAYMENT
Amount $
MasterCard/Visa only
Name (as it appears on your card)
PLEASE MAKE SURE YOU INCLUDE THE COMPLETE CREDIT CARD NUMBER.
Card No. Exp. Date
To ensure that your credit card payment is authorized, the address listed above must be your exact billing address.
Quantity Number Item Price Total
*State/Province/Nation
JEWELRY & GIFTS POSTAGE & HANDLING CHART
(Does not apply to official badge #00 through #5.)
1-2 items $4 Total
3-5 items $5 Total
6 items & over $6 Total
Orders weighing more than 13 ounces, as well as orders shipped
outside the U.S., will require additional postage charges, which
may be billed separately.
CHAPTER SUPPLY ITEMS (S1-S55): Postage & handling applies
to chapter supply orders weighing 13 oz or more. An invoice for
postage & handling will be mailed with order.
SUBTOTAL
Postage & Handling (See chart.)
TOTAL
Please check orders promptly.
NO RETURNS OR EXCHANGES AfTER 30 DAYS.
ALPHA DELTA KAPPA DOES NOT
EXPRESS MAIL SHIPMENTS.
Allow up to four weeks for delivery.
VIOLET SHOP ITEMS ARE NOT AVAILABLE THROUGH INTERNATIONAL HEADQUARTERS.
PLEASE VISIT: http://www.cafepress.com/alphadeltakappa