Please print this form for your order and send to:

Military Artifacts, P.O. Box 404, Aubrey, Texas 76227

Use additional sheets if necessary.

Item Description Price Quantity Total

1 ___________________________________________________________________ $__________

2 ___________________________________________________________________ $__________

3 ___________________________________________________________________ $__________

4___________________________________________________________________ $__________

5___________________________________________________________________ $__________

Postage and Insurance (postage is $2.00 minimum for up to three patches and insurance is optional below $50.00 but customer assumes all risk, and is mandatory above $50.00) $__________

Texas residents please add 8.50 % sales tax $__________

Total enclosed (Cash, check or money order) $__________

Send to:

Name_______________________________________________

Address_____________________________________________

_____________________________________________

City __________________________State_______________Zip______________

Telephone___________________ Email _________________________

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