PLEASE PRINT THIS FORM AND SEND WITH PAYMENT TO

Preservation Delaware: Protecting the Irreplaceable in the First State

ORDER FORM

Name _____________________________________________

Group/Business ____________________________________

Address ___________________________________________

City _______________________________________________

State/Zip ___________________________________________

Phone _____________________________________________

Fax _______________________________________________

E mail _____________________________________________

____ Quantity

____ Gibraltar Ornament $24.95

(or $22.45 with 10% member discount)

____ Resource Directory $ 6.00

Please include $2 s/h for EACH Ornament and Resource Directory

Shipping/Handling $_________
Total $ _________

___Check Enclosed
Make checks payable to Preservation Delaware, Inc.

OR

___Charge VISA/MasterCard

____/____/____/____ Expires ___/___

Signature________________________