| DISTRICT 2008 |
| GWRRA PATCH ORDER FORM |
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| Mail Order to: |
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Send Form
to: |
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District Patch Shop |
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| Name |
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Mary Lou Stamm |
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| Address |
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2471 East 13th Avenue |
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| City/State/Zip |
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Columbus, NE 68601-3719 |
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mlstamm@megavision.com |
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| Email |
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FULL
PAYMENT |
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MUST
ACCOMPANY ORDERS |
| Date |
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MAKE CHECK PAYABLE TO GWRRA |
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COST |
QTY |
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| DESCRIPTION |
EACH |
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SPECIFY |
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| 10" RED GRIFFIN PATCH |
$10.00 |
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| 10"BLACK GRIFFIN PATCH |
$12.00 |
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| 4" RED GRIFFIN PATCH |
$4.50 |
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| 4" BLACK GRIFFIN PATCH |
$5.00 |
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| 4" LIFE MEMBER PATCH |
$5.00 |
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| REGION E BLACK PATCH |
$6.00 |
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| M.A.D. PATCH |
$6.00 |
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| 4" ORIGINAL WHITE MEMBER PATCH |
$2.00 |
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| 6" GWRRA ROCKER, WHITE/RED |
$2.50 |
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| COUNTY MAP SPECIFY STATE |
$6.50 |
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IA, IL, MN, MO, WI |
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| USA MAP |
$6.50 |
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| 4" STATIC CLING DECAL (HELMET) |
$1.00 |
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| 2" DECAL LEFT/RIGHT (HELMET) |
$1.00 |
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| 4" DECAL LEFT/RIGHT (HELMET) |
$1.50 |
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| 4" DECAL, RED GRIFFIN |
$1.00 |
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| INDIVIDUAL OF THE YEAR 4" PATCH |
$5.00 |
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| COUPLE OF THE YEAR PIN |
$5.00 |
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| COY YEAR BAR SPECIFY YEAR |
$2.00 |
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| COY BAR-CHAPTER/DISTRICT/REGION |
$2.00 |
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| MEMBERSHIP PIN RED GRIFFIN |
$3.00 |
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| MEMBERSHIP PIN BLACK GRIFFIN |
$3.50 |
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| MILITARY PATCH ACTIVE & SEAL |
$6.00 |
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BRANCH: |
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| MILITARY PATCH RETIRED & SEAL |
$6.00 |
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BRANCH: |
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| MILITARY PATCH RESERVE & SEAL |
$6.00 |
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BRANCH: |
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| MILITARY PATCH VETERAN & SEAL |
$6.00 |
0 |
BRANCH: |
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| MILITARY BRANCH SEAL ONLY |
$2.00 |
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| LAPEL PINS-LEFT/RIGHT (HELMET) |
$3.00 |
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TOTAL PAGE
1 |
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| PATCH COLOR CODES |
WHITE=W RED=R
BLACK=B |
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| TRIM COLOR CODES |
RED=R BLACK=B YELLOW=Y GOLD=G |
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| LETTER COLOR CODES |
WHITE=W RED=R BLACK=B
YELLOW=Y GOLD=G BLUE=BU |
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| ROCKERS |
COST
EACH |
QTY |
PATCH COLOR
CODE |
TRIM COLOR
CODE |
LETTER COLOR
CODE |
Total
Cost |
| BACK ROCKER (OVER 10"
PATCH) |
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$7.00 |
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$7.00 |
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$7.00 |
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$7.00 |
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| 2 lines |
$8.00 |
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| BACK ROCKER (UNDER 10"
PATCH) |
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$7.00 |
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$7.00 |
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$7.00 |
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$7.00 |
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| 2 lines |
$8.00 |
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| CITY BAR |
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$7.00 |
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$7.00 |
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$7.00 |
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| 2 lines |
$8.00 |
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| FRONT ROCKER OVER |
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$5.00 |
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$5.00 |
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$5.00 |
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| 2 lines |
$6.00 |
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| FRONT ROCKER UNDER |
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$5.00 |
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$5.00 |
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| 2 lines |
$6.00 |
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| POSTAGE
CHARGES |
Page 2 TOTAL |
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| $0.00 - $10.00 = $1.00 |
$150.01 - $175.00= $6.50 |
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| $10.01 - $20.0 =$1.50 |
$175.01 -
$200.00= $7.50 |
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| $20.01 - $40.00 = $2.00 |
$200.01 - $300.00= $8.50 |
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| $40.01 - $60.0 = $3.00 |
$300.01 -
$400.00= $9.50 |
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Total Page 1 |
$ |
| $60.01 - $75.00 $4.00 |
$400.01 -
$500.00 $10.50 |
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Total Page 2 |
$ |
| $75.01 - $95.00 $4.50 |
$500.01 -
$600.00 $11.50 |
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Sub Total |
$ |
| $95.01 - $150.00 $5.50 |
$600.00 -
$700.00 $12.50 |
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Postage /
Insurance |
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Total Amount |
$ |