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Attachment T ~ Official Chapter Banner Order Form

FOR OFFICE USE ONLY

2006 CHAPTER BANNER ORDER FORM

TRANSACTION DATE:

Directions:

1.

Member should fill out form completely.

PROCESSED BY: DATE PROCESSED: REMITTANCE NO:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

2. 3. 4. 5. 6.

Make check or money order payable to Alpha Phi Alpha Fraternity, Incorporated.

______________

Mail payments to PO Box 630792, Baltimore, MD 21263-0792 or fax to (410) 554-0054 for credit card payments. Keep a copy for your records. Please do not forget to include shipping and handling fees. A receipt will be sent upon request.

BILLING/SHIPPING INFORMATION

Chapter Name:

Key Number :

Chapter Founding Year:

Institution Name (college chapters only):

Address:

City, State Zip:

Email Address:

Home Telephone:

Quantity Description

ChapterBanne

Unit Price $185.00 Subtotal

Total

Shipping

$15.00

Balance Due

BANNER DESCRIPTION

Dimensions: 4x12 w/ 2 inch fringe along 12” bottom

CREDIT CARD PURCHASES (VISA, AMEX AND MASTERCARD ACCEPTED)

TYPE: NUMBER:

EXP. DATE: SIGNATURE: DATE:

Material: Nylon

Print Type: Silk Screen

Printing Format:

Alpha Phi Alpha Fraternity, Inc. 19 “SHIELD” 06 *******

Line 1: CHAPTER NAME Line 2: INSTITUTION NAME (college chapters only) Line 3: CHAPTER SEAT LINE 4: FOUNDING DATE

C/O:

55

15th Draft 9/18/07

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