Rotary Special Offers On-Line Order Form

Special Offers Order Form

ORDER INFORMATION

Rotary Club Name:

Special Item	Quantity	Package Price	Total

Gold plated Rotary member pin		$1.60/ea
Gold plated magnetic Rotary member pin		$3.25/ea
DuraHyde Compu-Attaché		$39.00

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

SHIP TO ADDRESS

Your Name:
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		Year

Name as it Appears on the Card:

Billing Street Address:

City, State, Zip Code:

Province (Outside USA):

Country:

(Will ship within 48 hours)

Parker Systems, Inc.
20989 Middleton Drive
Lake Zurich, Illinois 60047-8698 USA

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