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)  Name _____________________________________________________________

                           Address _________________________________________________________________

                           City__________________________ County_____________ State________Zip_________

                           Daytime Phone (______)_____________________ Event Date/Date Needed By  _________

                           Special Shipping Instructions__________________________________________________

Indicate Style: ÿPin back        ÿClip back        ÿFoldover pocket        ÿMagnetic back
                         ÿ District Warden   ÿDistrict Warden's Wife

Indicate Color: ÿBlue    ÿLight blue    ÿWhite/Blue letters   ÿWhite/Red letters    ÿGold metallic
                    ÿOther color (Please Specify) _________________________

Indicate Emblem: ÿ 3rd degree   ÿ 4th degree   ÿ 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  @ $7.00 .............. __________

______   Foldover or magnetic @ $7.75 ...... __________

______   Gold Florida State Shapes @ $1.00  __________

                10 or more badges 10% discount __________

                S & H – 1-4 - $6.00 ....................... __________

                S & H  - 5 & over - $8.00 .............. __________   

                 FL sales tax ................................. __________  (Based on your county - Minimum 6%)

               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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