DignityUSA - Solidarity Sunday Order Form

Solidarity Sunday™ Order Form

Please print out the form below, complete it, and mail to:

DignityUSA, Attn. Solidarity Sunday, PO Box 15373, Washington, DC 20003-0373
or Fax: 202.543.5511 or E-mail: solidaritysunday@dignityusa.org

If you have questions, please contact DignityUSA at 800.877.8797, 202.861.0017, or solidaritysunday@dignityusa.org.

Solidarity prayer cards

(please order in sets of 100 @ $19/set).

Specify quanity: with prayer _____ without prayer_____

PRAYER CARD SUBTOTAL $ ___________

Postage

Orders less than $20	$4.50 for S&H
Orders $20 - $50	$7.50 for S&H
Orders $50 - $100	$13.00 for S&H
Orders above $100	$18.00 for S&H
Overnight delivery	extra charge applies (to be billed)

POSTAGE $ ____________

Additional Donation to DignityUSA

DONATION $_____________

TOTAL AMOUNT DUE $ _____________

Payment Information

_ Check or money order enclosed (made payable to DignityUSA)

_ VISA _ MasterCard Card # _______________________________________ Exp. ___________

Signature _____________________________________________________

Ship to: (please print)

Name _____________________________________________________________

Organization ____________________________________________________

Address __________________________________________________________

City__________________________________________________________

State__________ Zip _____________________ Country _______________________________

Telephone (_________) __________________________________________

E-mail _________________________________________________________