Please clearly print the words as they are to appear on the badge.
Pick style/format that you like from the photos (A, B, C, D) _________________
First name: _____________________ Last name: ______________________
Chapter: _____________________________ (or leave blank)
City, State of Residence: __________________________________ (or leave blank)
** Hanger: ______________________________________________ (if you choose)
** Please note: If you would like, the hanger can have your Chapter name, your city/state,
or both your Chapter name and your city/state on two lines. Hangers can also be used to
indicate the office you hold in your Chapter or with RVW.
Badge Price with pin back @ $8.50 each: $____________
Badge Price with magnet back @ $11.50 each: $____________
Hangers @ $4.00 each: $____________
Shipping @ $3.00 for 1st Badge +$.50 each add’l $____________
Total Enclosed: $____________
Ship to: Name: ___________________________________________________
City: _________________________ State: _______ Zip: ___________
Please enclose check payable to: Badges “R” Us
Badges “R” Us
PO Box 22012
Mesa, AZ 85227
We accept Credit Cards. CALL US FOR FASTER SERVICE!
Questions: Call (760) 212-0682 or email email@example.com