USA Council of Serra International

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					USA Council of Serra International
Merchandise Order Form
Please complete the following form to request materials and merchandise for your club activities.
Please indicate whether you are using a commercial or residential address. Using a commercial
address will reduce shipping costs and improve delivery time. Also, please use a street address
because UPS will not ship to PO boxes. Finally, we also would be very happy to accept your credit
card.

 Commercial address                SHIP TO:                                    BILL TO:
 Residential address               (Billing address of credit card)            (If, different from shipping
                                                                                address)
Name:
Street, Apt or Suite #:
City, State, Zip:
Daytime Telephone:
Email Address:
Print name exactly as it appears on credit card
Card Number:                                                 Expiration date (month/year):

                          Please charge my :                                   (Circle one)

                                                                                               Price       Total
Quantity      Item #       Description                                                         Each        Price
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                            $              $
                                                                                    Merchandise Total      $

   Standard shipping and handling charges apply; we will automatically add these or the actual shipping
                             charges for expedited orders to the total bill.
   Note prices of materials, merchandise, and shipping and handling charges are subject to change without notice.
                                                                     nd
     (Check one if desired):  UPS Next Day Air             UPS 2        Day Air      UPS    Three Day Select

Return orders by mail to: USA Council of Serra International, 65 E. Wacker Place Suite 802,
                          Chicago IL 60601, or FAX 888.777.6803
                      Telephone orders are accepted at: 888.777.6681