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Solidarity Sunday™ Order Form

Submitted by dignityusa on Fri, 08/08/2008 - 15:08

Solidarity Sunday™ Order Form

Please print out the form below, complete it, and mail to:

DignityUSA, Attn. Solidarity Sunday, PO Box 376, Medford, MA 02155
or Fax: 781.397.0584 or E-mail: solidaritysunday@dignityusa.org

If you have questions, please contact DignityUSA at 800.877.8797, 202.861.0017, or solidaritysunday@dignityusa.org.

Solidarity prayer cards

(please order in sets of 100 @ $19/set).

Specify quantity: with prayer _____       without prayer_____    

PRAYER CARD SUBTOTAL $ ___________

Postage

Orders less than $20

$4.50 for S&H

Orders $20 - $50

$7.50 for S&H

Orders $50 - $100

$13.00 for S&H

Orders above $100

$18.00 for S&H

Overnight delivery

extra charge applies (to be billed)

POSTAGE $ ____________

Additional Donation to DignityUSA

DONATION $_____________

TOTAL AMOUNT DUE $ _____________

Payment Information

_ Check or money order enclosed (made payable to DignityUSA)

_ VISA     _ MasterCard Card # _______________________________________   Exp. ___________
 

Signature _____________________________________________________

Ship to: (please print)

Name _____________________________________________________________

Organization ____________________________________________________

Address __________________________________________________________

City__________________________________________________________

State__________ Zip _____________________ Country _______________________________

Telephone (_________) __________________________________________

E-mail _________________________________________________________

 

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