POW/MIA/KIA/ Military, Police Officers, Firefighters, /EMT/EMS or your hero Bracelet Order Form
Sterling Silver 12 Gage $109.99--- Sterling Silver 14 Gage $89.95 These
are 7" X 15mm wide
Please make your selection below and then print this form out on your printer.
Name: ______________________________________________________________
Branch: ____________________________ Rank: ___________________________
Date of Loss: ________________ or KIA/Line of Duty______________ if known
Line 1__________________________________________________
Line 2__________________________________________________
Line 3__________________________________________________
After printing, complete this form and mail with your remittance to:Note: you must list a valid phone number-- we had had several orders where they were mailed and the credit cards were declined and we have no way to contact you--
| Ship to: Must be the same as Bill To Address-- Unless paid by money
order: Name: __________________________ Address: ________________________ City: ___________________________ State, ZIP: ____________________ email address ___________________________ Phone Number ----------------------------------------------- | Bracelet Cost: ____________________ Washington Residents add sales tax 8.6%: ___________________ Shipping: ________________________ US Postal Service - $6.75 Priority Mail Only Total: ___________________________ |
| Visa/MasterCard/American Express/Discover or PayPal Accepted | Account #: _________________________ Expiration Date: ____________________ CVV Code_______________ |
Questions concerning multiple bracelet orders or family discount Can be viewed on our secure site at www.americanhonor.net/store Questions concerning multiple bracelet orders or family discount
Sunday, October 09, 2005 06:53:11 AM