CAMPAIGN PINS ORDER FORM

 

Please PRINT this page and fill in the information and send,
along with a check or money order payable to "Hirschmann/Munter", to:

 

Hirschmann/Munter
315 W. 86th St., Suite 17B
New York, NY 10024

 

Name:__________________________________________________________________

Hm PH: (_____)____________________ Wk PH: (_____)________________________

Address: _____________________________ City:_____________ ST___ Zip________

E-Mail:_________________________________________________________________

 

Number of
Gold Pins
Number of
Silver Pins
Total Number
of Pins
Prices
Amount
Enclosed for pins:

1 - 9 - $ 5 each

10 or more - $ 3 each

Shipping & Handling:
Amount
Enclosed for S&H:

1 - 25 pins - $ 5.00

26 pins or more - $7.00

Total Amount
Enclosed:

 

 

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