Upper Leacock Fire Company Store Order Form
| Reflective Address
Sign (Upper Leacock Township Resident) Numbers Requested on Sign (up to 5) ____ ____ ____ ____ ____ Orientation (Circle one): Horizontal Vertical Sign $15 Delivery - Free Total cost = $15 Post available for $5 fee
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| Reflective Address
Sign (non-Upper Leacock Township Resident) Numbers Requested on Sign (up to 5) ____ ____ ____ ____ ____ Orientation (Circle one): Horizontal Vertical Color choice (Circle one): Green Blue Sign $15 Shipping and Handling $5 Total cost = $20
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| ULFC Patch
Patch with shipping and handling $5 Additional patches $3 each Number requested: ______
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| ULFC Sauerkraut Hat
Year(s) Requested (32,33,34, etc): ______________________________ Sauerkraut Hat $8 (each) Shipping and Handling $5 Total cost = $13 Three (3) hats $20 Shipping and Handling $7 Total cost = $27
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Please complete the following: Mail To:
Name: _______________________________ Upper Leacock Fire Company
Address: ____________________________ Attn: Store
City, ST, ZIP: ______________________ PO Box 335
Phone Number: __________________ Leola, PA 17540
Total Enclosed : $ ______________ Checks payable to: Upper Leacock Fire Company