Please print and complete this form.  Either  fax the form to 316-221-6687, or call tollfree at 877-732-2170 to place your order.  If you prefer email, include all of the information requested below in a text message to Sea-Graphics, Inc.  You will receive an email confirmation of your order within one day.  

DATE:  __________________

*REQUIRED FIELD

 Design¹

 Price

 Each

1 - Select your design from among your club's Stock Designs as shown on page one of your store.

2  - VA residents add 5% sales tax to total.

3 - Should you need additional space, print this form twice and mark "Page 2" in the upper left before faxing. 

4 - Please allow three weeks for delivery, unless otherwise noted in the catalog section.

Thank you!

MasterCard [  ]  Visa Card [ ]    Number:_____-_____-_____-_____  Expiration Date:_______

Name on Card:____________________________

Street Address:___________________________

City/State/zip:____________________________