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 $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.

Press Ctrl-P to Print