Order Challenge Coins

Purchase Challenge Coins

Please print and mail to the address at the bottom of the page.

Quantity_____Cost (Member Dues Current) $5.00 ea Total_$_______ (# Coins*cost ea Member)
Quantity_____Cost (Non-Member) $6.00ea Total_$_______ (#Coins *cost ea Non-Member)
Shipping and Handling 1-4 $2.50, 5-10 $4.50, 10-15 $6.00 Total_$_______
(max 15 coins)

Total Coins Purchase + Shipping and Handling Total_$_______

Note Member is someone whose dues are current in the BN records..

Ship to Address

Name ___________________________________________

Address_____________________________

City______________State______

Zip Code___________

Your Email Address ___________________________________________

Mailing Information
Note: Print this form out and mail in with your check or Money Order.
DO NOT MAIL CASH

John Holladay
12603 County Road 1113
Athens, Tx 75751

Make Check or Money Order payable to:

John Holladay

email Doc Holiday @

johnholladay@outlook.com

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Please print and mail to the address at the bottom of the page.
Quantity_____Cost (Member Dues Current) $5.00 ea	Total_$_______ (# Coins*cost ea Member)
Quantity_____Cost (Non-Member) $6.00ea	Total_$_______ (#Coins *cost ea Non-Member)
Shipping and Handling 1-4 $2.50, 5-10 $4.50, 10-15 $6.00	Total_$_______
(max 15 coins)
Total Coins Purchase + Shipping and Handling	Total_$_______