Merchandise Order Form

Mailing Information

Full Name:	____________________________________________________
Address:	____________________________________________________
	____________________________________________________
Telephone:	_____________________
Email:	_____________________

Are you a member? Yes No
Would you like additional information about the society? Yes No

Merchandise Ordered

Item	Quantity	Size	Price each	Total
Haley Shirt
Haley Hat
All prices include tax. The Haley H&TS is a non-profit organization. All proceeds from the sale of merchandise are applied toward society activities.			Sub-Total:
			Postage:	7.50
			Total:

Mailing Address

Please mail this completed form, along with your remittance, to:

The Haley Tower Historical & Technical Society
PO Box 10291
Terre Haute, IN 47801

Please use the above address for merchandise orders only!
If you have questions or comments for us, please see the Contact Information page.
You should receive your receipt and materials within 10 working days.