Rotary Membership Card On-Line Order Form

Imprinted Membership Card Order Form

INFORMATION REQUIRED BY ROTARY FOR FRONT OF CARDS

Rotary Club Name:

Certified By (Club Secretary's Name):

Valid Until
Date:

	/		/
Mo		Day		Year

District
Number:

Club
Number:

ORDER INFORMATION

Membership Card Format	Quantity	Unit Price	Total

Imprinted Cards		$1.95
Durahyde Compu-Attaché		$69.00
Magnetic Rotary member pin		$3.25
Rotary member pin		$1.60

		Sub Total
	7% Sales Tax (Illinois residents only)
	Shipping charges will be added
		ORDER TOTAL

SHIP TO ADDRESS

Street Address:

City, State, Zip Code:		,
Province (outside USA):
Country:
Phone Number:
Fax Number:
E-mail Address for Order Confirmation:

CREDIT CARD INFORMATION:

Type of Card:

Account Number:

Expiration Date:

	/		/
Mo		Day		Year

Name on Card:

Card Billing Street Address:

City, State, Zip Code:

Province (outside USA):

Country:

MEMBERS TO RECEIVE IMPRINTED CARDS
(Note: The best way to send us your list of members is to download our
MemberInformation spreadsheet and your members list from Rotary.org by following
the instructions that appear after you click the "Send This Order" button below.)

and

(Allow approximately 2 weeks for delivery)

Parker Systems, Inc.
20989 Middleton Drive
Lake Zurich, Illinois 60047-8098

(800) 253-5100 - (847) 726-8600 - Fax 726-8610

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