Connecticut Housatonic Chapter Merchandise Order Form
Thank you for your support
In Service to Others. All proceeds' are used for our fundraising efforts! Tracking number will be provided to you upon shipping.
Name
*
First Name
Road Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
My Products
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Challenge Coin
$25.00
$
25.00
Quantity
1
2
3
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9
10
Poker Chip
$6.00
$
6.00
Quantity
1
2
3
4
5
6
7
8
9
10
Zippo Lighter
$75.00
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Flask
$22.00
$
22.00
Quantity
1
2
3
4
5
6
7
8
9
10
Tumbler
$22.00
$
22.00
Quantity
1
2
3
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5
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9
10
Payment Methods
Choose from one of the PayPal options to
make your payment.
Submit
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