Medallions Unlimited
P.O. Box 6631 - Lubbock, Texas 79493

Group Order Form:
Standard Medallions		 Page 1 Of 2:
Product Selection		 Prices Effective March, 2001
All Other Prices Void
     
ANODIZED ALUMINUM: Various Colors, Serenity Prayer Reverse. Price Each: 75¢
        Item                  Qty         Item                  Qty         Item                  Qty         Item                  Qty Sub-Total
Day At A Time:   24 Hours:   1 Month:   2 Month:    
3 Month:   4 Month:   5 Month:   6 Month:    
7 Month:   8 Month:   9 Month:   10 Month:     
11 Month:         
TOTAL Aluminum Medallions:  

ANTIQUE BRONZE: Serenity Prayer Reverse. Price Each: $1.00
        Item                  Qty         Item                  Qty         Item                  Qty         Item                  Qty Sub-Total
24 Hours:   1 Month:   3 Month:   6 Month:    
9 Month:   18 Month:   1 Year:   2 Year:    
3 Year:   4 Year   5 Year:   6 Year:    
7 Year:   8 Year:   9 Year:   10 Year:    
11 Year   12 Year   13 Year   14 Year    
15 Year   16 Year   17 Year   18 Year    
19 Year   20 Year   21 Year   22 Year    
23 Year   24 Year   25 Year   26 Year    
27 Year   28 Year   29 Year   30 Year    
31 Year   32 Year   33 Year   34 Year    
35 Year   36 Year   37 Year   38 Year    
39 Year   40 Year   41 Year   42 Year    
43 Year   44 Year   45 Year   46 Year    
47 Year   48 Year   49 Year   50 Year    
51 Year   52 Year   53 Year   54 Year    
55 Year                
TOTAL Bronze Medallions:  


IMPORTANT: To complete order provide Payment/Shipping Information on Page 2


For information or assistance with your Order telephone toll free: 1 877 797-8526.

Page 2 of 2:
Payment/Shipping/ Information (updated 03/06/02)

Special Instructions: If order sub-total is $100.00 or more deduct 10%.
If sub-total is $50.00 or more shipping is FREE (see Shipping Charges below).

Shipping/Handling Charges:
On orders of less than $50.00, add $5.75. Orders of $50.00 or more are shipped FREE.
Texas residents please note: State law requires that sales tax be applied to your purchase and shipping.
We routinely ship USPS Priority Mail (US ONLY). Allow 5 - 7 business days for delivery.

Total Aluminum Medallions:   @ 75¢ each $
Total Bronze Medallions:   @ 1.00 each $
Sub-Total: $
Discount: if sub-total is $100.00 or more deduct 10%):  
Shipping: if sub-total is less than $50.00, add $5.75:  
Taxable Sub-Total: $
Sales Tax (Texas residents only, currently 7.875%):  
TOTAL - Pay this Amount: $

Personal Information:
Name (first and last):
Home Phone: Work Phone:
E-mail: Fax #:
Billing Address:
Street: City:
State: Zip: Country:
Shipping Address (if different from Billing):
Street: City:
State: Zip: Country:

We accept MasterCard and Visa, check or money order. Note: Credit card purchases less
than $25.00 will be billed a $3.00 processing fee. Processing fee applies to credit card orders ONLY.
Payment Method: Check:            Money Order:            MC:            Visa:           

NOTE: If payment is by credit card the Name and Billing Address must be the same as the
person whose name appears on the card (card holder). The CVV2 number is the last
3 digits of number that appears on reverse side of the card.
Name on Card:
Card #: CVV2 #: Exp. Date:

Mail completed Order Form with Payment to address at the Top of Page One

For information or assistance with your Order telephone toll free: 1 877 797-8526.

You are invited to Shop Online. Go to: http://www.medallionsunlimited.com/store/mu/index.html