Printable Order Form

Date:	________________________________________________________________
Name:	________________________________________________________________
Member#:	_______________________________________________ (found on HLC label)
Street:	________________________________________________________________
City, St, Zip	________________________________________________________________
Phone:	________________________________________________________________
E-Mail:	________________________________________________________________

ITEM #	DESCRIPTION	COLOR	QTY.	SIZE	PRICE/ITEM U.S. Dollars	TOTAL AMOUNT
Make check payable to and mail to: Clan Irwin Association 226 1750 Ave. Mt. Pulaski, IL 62548-6635		SUBTOTAL
		IL residents add 6.25%
		Non-Members add 15% to total order
		SUB-TOTAL
		US S/H (see chart below)
		TOTAL
Thank you for your order!

SHIPPING / HANDLING:
Sub-Total	S/H
up to $25.00	$5.95
$25.01-50.00	$7.95
$50.01-75.00	$9.95
$75.01-100.00	$10.95
$100.01-125.00	$12.95
125.01-150.00	$13.95
150.01-200.00	$14.95
200.01-300.00	$16.95
300.01 or more	$18.95
U.S. Books at book rate or at Priority Rate if faster srvice requested. Merchandise, Books shipped to Canada/Overseas at exact cost of shipping.

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