1735 N.E. Jacksonville Rd. Ocala, Fl 34470

Local: 352-732-2249 – Toll Free: 1-800-291-8993 – FAX: 352-629-1317

Knights of Columbus Name Badges

SHIP TO: (please print)  N ame_____________________________________________________________

                                     Address __________________________________________________________

                                     City_________________________________State_____________Zip_________

                                     Daytime Phone (______)_____________________Event date_____________

                                     Special instructions_________________________________________________

Indicate Style: ÿPin back        ÿClip back        ÿFoldover pocket        ÿMagnetic back    ÿ District Warden  

                                                                                                                                       District Warden's Wife

Indicate Color: ÿBlue       ÿLight blue        ÿWhite/blue letters     ÿGold metallic     ÿOther color

Indicate Emblem:  3rd degree      4th degree      Engraved state shape      ÿ Gold state shape (Add $1.00)  

Council / Assembly Name: __________________________________________________________  

Council / Assembly #: ______________________ City: ___________________________________

NAME: ___________________________________  TITLE: ________________________________

NAME: ___________________________________  TITLE: ________________________________

NAME: ___________________________________  TITLE: ________________________________

NAME: ___________________________________  TITLE: ________________________________

NAME: ___________________________________  TITLE: ________________________________

NAME: ___________________________________  TITLE: ________________________________

NAME: ___________________________________  TITLE: ________________________________

QUANTITY                                                          TOTALS

______   Pin or Clip back  @ $5.50                  __________

______   Foldover or magnetic @ $6.50          __________

______   Gold Florida State Shapes @ $1.00    __________

               10 or more badges 10% discount    __________

               S & H – 1-4 - $6.00                            __________

               S & H  - 5 & over - $9.00                   __________   

               FL sales tax 6.5%                               __________

               TOTAL ENCLOSED                            __________        

Please mail this order with payment to the above address. OR for faster service FAX this form and call with a credit card!

For Fast Friendly Service

CALL  (352) 732-2249 - 1-800-291-8993

FAX   (352) 629-1317

or E-Mail  sales@bjtrophy.com

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