Penn-Dutch Club Store Order Form

(please print out, fill in, and mail to the address below with your check made out to PDGPC)

Item # Quant. Description Size Color Price (each) Total

$

$

$

$

$

$

ORDER TOTAL
$

Ship to:

Name

Street address

City, state & zip

Phone # w/area code

E-mail address

Please mail completed forms to Fred Unger, 3138 Friedens Rd., Slatington, PA 18018.
Be sure to include check or money order made out to PDGPC.

NOTE: All prices include shipping and handling.

Thank you for your order.


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Item #	Quant.	Description	Size	Color	Price (each)	Total
						$
						$
						$
						$
						$
						$
ORDER TOTAL						$
Ship to:
Name
Street address
City, state & zip
Phone # w/area code
E-mail address