Bethabara Order Form

250th Commemorative Items Order Form

Item	Order Quantity	Price	Shipping	Item Total

Southern Province Throw	_____	$40.00	$5.00 each	________

Bethabara Throw	_____	$40.00	$5.00 each	________

Cookbook	_____	$17.00	$3.00 each	________

Lapel Pin	_____	$7.00	$1.00 each	________
Order Total __________

Thank you for your order. Please Print out this Order Form and:

    Mail to:                                                                  Fax to:
    Bethabara Moravian Church                                                336-924-8789
    ATTENTION: Church Treasurer
    2100 Bethabara Road                              OR                      Telephone: Office
    Winston-Salem, NC 27106                                                      336-924-8789

        Along with your Check

Items will be shipped within 7 days of the check clearing..
Information provided on this order form will be used to process this order only.