PATCH ORDER FORM

Thanks for your order, all profits go into the C/227th Fund to defray any expenses occurred for this and future reunions.
Dennis Beckler
5239 E 5^th St S
Newton, IA  50208-8474
Home Phone 641-791-9505
dadbklr@pcpartner.net

You can print this form and mail to Dennis at the address above

Patches are 4 1/8 inches across

AND

    .

Personalized embroidered name patch - And -Ghost Rider Patch

Both for $20.00.....................................................................Qty ___

Name to be embroidered on namepatches ...... _________________________________

Name to be embroidered on namepatches ...... _________________________________

Name to be embroidered on namepatches ...... _________________________________

~Suggestion: Rank along with last name. Example; Sp/5 Beckler, WO2 Smith, 1^st Lt. Rankin, etc.~

Silver Wings Name Patch without a name embroidered  AND  the Ghost Rider Patch

Both for $18.00......................................................................Qty ___

The Ghost Riders patch Alone is $10.00..............................Qty ___

The Silver Wings Name patch with personalized name embroidered is $10.00.Qty ___

 or

The Silver Wings Name Patch alone without a name embroidered is $8.00.......Qty ___

Indicate your preference below:

Bring the patches to DC.........................................................................................________

or

Mail them to you / please add $4.00 to the total for shipping charges .................________

Please fill out the address form:

Name:         ________________________________

Address:     ________________________________

City & Zip: ________________________________

Phone #       ________________________________
E-mail: ___________________________________

Total Amount enclosed:    $ ___________________

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