Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Select which items you would like to purchase:

Belt Buckle #1 Silver ( $40.00)
Belt Buckle #2 Antique Brass ( $25.00)
Tie Tack  ( $ 2.00 )

Denim Shirt  ( $22.00) - specify size below
Sport Shirt  ( $20.00) - specify size & color below
T-Shirt  ( $12.00 ) - specify size & color below

Sweatshirt  ( $20.00 ) - specify size & color below

OPOA Directory  ( $20.00 with cover, $15.00 insert only)

"Police Line" Lanyard   ($5.00)

  Leather Notebook w/ Insert - Small  ($20.00)

  Leather Notebook w/ Insert - Large ($20.00)

  Travel Coffee Mug   ($8.00)

Long Sleeve T-Shirt  ( $12.00 ) - Black or Navy /OPOA on sleeve - specify size & color below

 

NOTE: please add $3.00 for S & H to any merchandise order or the first five directories ordered. ( .60 per directory after that)

Please specify quantity, size and color (if applicable) below:

Enter the total amount of your purchase, including shipping and handling:

Choose one of the following credit cards:

Visa Mastercard

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Enter the 3-digit security code (from back of card) :

Enter the date of expiration :

Enter the name as it appears on the credit card in the space provided below.

Enter any other specific information that pertains to this purchase:

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