Centennial Coin Order Form

Help Support Veterans in the State of Maine and Buy your Maine Centennial Coin Today!

To pay by Paypal or Debit/Credit card, please fill out form below, select Payment Section (Page 2) amd choose OPTION 1 or 2; proceed by pressing the Submit Online Payment button. You may also mail your check or money order to: The American Legion, Department of Maine, 5 Verti Drive, Winslow, Maine 04901-0727 (See details, Page 2). Centennial coins cost $10 each plus $5 shipping/handling. Coins are also available for FREE PICKUP at Department Headquarters for $10 each. If paying online a 3.8 % Transaction Fee will apply.
Full Name*

First NameLast Name
Shipping Address*

Street Address

CityState

Zip Code
E-mail
example@example.com
Contact Number

Area CodePhone Number

Payment Section (Page 2)
PAY BY PAYPAL OR DEBIT/CREDIT CARD (Select only 1 OPTION)
prevnext( X )
Centennial Coin Online Payment OPTION 1 (Includes $5 Shipping/Handling)$10.00

Quantity

Centennial Coin Online Payment OPTION 2 (FREE PICKUP)$10.00

Quantity

Subtotal $0.00Tax $0.00Shipping $0.00Total $0.00
TO PAY BY CHECK OR MONEY ORDER, please indicate your selection below, print the completed form and mail form along with your check or money order to: The American Legion, Department of Maine, 5 Verti Drive, Winslow, Maine 04901-0727.
Please mail my Centennial Coin(s): Includes $5 Shipping/Handling
Quantity/$ Amount
I will pick up my order at Department Headquarters: FREE PICKUP
Quantity/$ Amount
Thank you for your Support!

The American Legion, Department of Maine, 5 Verti Drive, Winslow, Maine 04901-0727

www.mainelegion.org | Phone: (207) 873-3229 | Fax: (207) 872-0501
Should be Empty: