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PIN MARKETPLACE
Order Form
Mail to: PIN MARKETPLACE 104 Stratford Lane Wallingford, PA 19086 U.S.A. Name _____________________________________ Telephone __________________ Address __________________________________ Email address __________________ __________________________________ Credit Card (MC/Visa/Disc/AMEX) Card # __________________________ Exp ______ CVV _________ Signature ___________________________________ (last 3 digits on back) Olympic Pin Interests _______________________________________________________ (media, previous Olympics, mascots, sponsors, etc.) How did you hear about PIN MARKETPLACE _______________________________________ (ad, web search, friend, etc.) Item # Description # ordered price ea. TOTAL ------------------------------------------------------------------------------ | | | | | | |_________|_________________________________|__________|__________|__________| | | | | | | |_________|_________________________________|__________|__________|__________| | | | | | | |_________|_________________________________|__________|__________|__________| | | | | | | |_________|_________________________________|__________|__________|__________| | | | | | | |_________|_________________________________|__________|__________|__________| | | | | | | |_________|_________________________________|__________|__________|__________| | | | | | | |_________|_________________________________|__________|__________|__________| | | (Pins - $2.00 $0-$25, $3.00 for $25-$50, SUBTOTAL |__________| $4.00 for $50-$75, $5.00 for $75-$100 | | Add $1.00 for each additional $50 SHIPPING |__________| Bags, Frames, Plush Mascots and | | Foreign shipments, check with us.) T O T A L |__________| Money order, check or travelers check payable to LARRY EHMER Phone Orders - (610) 565-0254 email Orders – Order@Pinmarketplace.com |