Clan Irwin Association, Inc.
226 1750 Ave.
Mt. Pulaski, IL 62548-6635
(217) 792-5226
guyirvin@frontiernet.net

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 $6.95
$25.01-50.00 $9.25
$50.01-75.00 $11.45
$75.01-100.00 $12.60
$100.01-125.00 $14.89
125.01-150.00 $16.04
150.01-200.00 $17.19
200.01-300.00 $22.00
300.01 or more $24.00
Kilts and Jackets shipped at our cost.
Books shipped at book rate unless you request Priority Mail.

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