United Bowhunters Of Pennsylvania
			581 Madison Shop Road
			Rimersburg, PA 16248-2631

	Print this form out and fill it in with your order and send via US Postal Service 
			Use your credit card for faster service

	Circle One: 	Check/Money Order Enclosed
			
			Visa	Mastercard	American Express

			Account # _________________________________

			Expiration Date ___________________________

			Name ______________________________________

			Street Address ____________________________

			City ______________________________________

			State ______________ Zip __________________

			Phone # _____ ________ ( include area code )

			Email address _____________________________

	Use the full description of the item(s) you are ordering. Be sure to state 
	the color, size, and quantity. If you need more room write it on the back.
                Shipping & Handling will be added to your order at the following rates:
	$0-$25=$4.95,  $25.01-$50=$7.95, $50.01-$75=$8.95, $75.01-$100=$10.95,
        $100.01-$150=$12.95, $150.01-$200=$13.95, $200.01-$250.00=$14.95
	Over $250=$16.95 ( Patches Only ! Up to 4 for $1.00 )

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