Ronald W. Reagan Presidential Series Medal Order Form

RONALD W. REAGAN PRESIDENTIAL MEDAL

Special Free Offer! Become a Signature Sponsor or Foundation Patron and receive the rare Reagan Presidential Medal free, plus other great benefits from the Clovis Free Press Foundation! To learn more about our free offer, click here.

~ PURCHASE ORDER FORM ~
Those who wish to purchase this item may use the following order form:

Billing Address and Contact Information
Enter your billing information as it appears on your monthly credit card statement. Items marked with an asterisk(*) are required to place your order. Because of limited quantities, orders are limited to 2 medallions per person.

Name*
E-mail*
Billing Address 1*
Billing Address 2
City*
State/Province*
Zip Code*
Phone Number* [ (555)555-5555]
Country*

Shipping Address (optional)
Fill out this section only if your Shipping Address
is different from your Billing Address.

Name
Shipping Address 1
Shipping Address 2
City
State/Province*
Zip Code*

Quantity & Payment Method
Choose your payment method and enter your account information.

$525.00 each. Order Quantity (limit 2 per person)
Visa M/C
Credit Card Number*
Name on Card*
Expiration Date*

After you have entered all required information and you are ready to place your order, press the button below to send it securely. Your Information is encrypted for your protection and will not be given or sold to anyone.

Once your order has been processed you'll receive written confirmation at the e-mail address you have supplied above.

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