Print this page, fill in the required information, and mail to the address shown below. Please print neatly.
|Name . .||_______________________________________|
|Mailing address . .||_______________________________________|
|City/town . .||_______________________________________|
|State . .||_____ Zip Code . . _________________|
|Phone number . .||_______________________________________|
|Email address . .||_______________________________________|
Qty Price Total LT Trail Guide with maps: ___ x $16.00 ________ (see Note 1) LT Patches: ___ x $2.00 ________ Shipping & Handling Charge: ________ (see Note 2) Subtotal: ________ 6% PA Sales Tax: ________ (see Note 3) Total Amount Due: ________
|Make checks payable to:||Alpine Club of Williamsport|
|Mail this form with your check to:||Alpine Club of Williamsport|
|PO Box 501|
|Williamsport PA 17703|
By using a check for payment, you agree to the following terms:
In the event your check is dishonored or returned for any reason, you authorize us
to electronically (or by paper draft) re-present the check to your bank account for
collection of the amount of the check, plus any applicable fees as permitted by state law.
See Contact Information page for details about local sales.