Purchase Challenge Coins

Please print and mail to the address at the bottom of the page.
Quantity_____Cost (Member Dues Current) $3.50ea	Total_$_______ (# Coins*cost ea Member)
Quantity_____Cost (Non-Member) $5.00ea	Total_$_______ (#Coins *cost ea Non-Member)
Shipping and Handling 1-4 $2.50, 5-10 $4.50, 10-15 $6.00	Total_$_______
(max 15 coins)
Total Coins Purchase + Shipping and Handling	Total_$_______

Note Member is a Dues paying member.

Ship to Address

Name ___________________________________________

Address_____________________________

Address_____________________________

City______________State______

Zip Code___________

Your Email Address ___________________________________________
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Mailing Information

Note: Print this form out and mail in with your check or Money Order.
DO NOT MAIL CASH

John Holladay
1921 Liverpool Dr
Plano, Tx 75025

Make Check or Money Order payable to:

John Holladay