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BESO MEDAL ORDER FORM
Medals
cost $15.00 and are shipped priority.
Please complete the following items.
NAME OF UNIVERSITY
*
COMPLETE NAME OF RECIPIENT
*
PLEASE PROVIDE THE ADDRESS YOU PREFER THE MEDALS BE SHIPPED TO. (USUALLY UNIVERSITY ADDRESSES TAKE LONGER TO RECEIVE)
*
CITY
*
STATE
*
ZIP
*
PHONE NUMBER
*
EMAIL ADDRESS
*
Please mail me (state quantity) medals.
*
Payment Information
Credit Card Type
*
VISA
Mastercard
AMERICAN EXPRESS
DISCOVER
CREDIT CARD NUMBER
*
CVS CODE
*
Exp. Date(mm/yy)
*
Cardholder's Name
*