| Color Choice | Price $ | Quantity |
| Dark Walnut | $79.00 | |
| Teak | $79.00 | |
| Oak | $79.00 | |
| Black | $79.00 | |
| Red | $79.00 | |
| Royal Blue | $79.00 | |
| Yellow | $79.00 | |
| White | $79.00 | |
| Forest Green | $79.00 | |
| Orange | $79.00 | |
| Brown | $79.00 |
___________ Sub Total
___________ *Shipping (Free for the 48 contiguous U.S. states)
$__________Total Cost
*Shipping to HI, AK or PR additional $10.00 per piece. $20 for international shipments
Name_________________________________________________________________
(Please note that this new certificate will be issued in the same name as your first original certificate)
Street (no p.o. boxes) ___________________________________________________
City_________________________________State_________Zip_________________
Day Phone (_______)___________________
E-Mail Address (used to confirm receipt of order)______________________________________________________
Date of Initiation ______________________________________________________
College/University of Initiation ______________________________________________________
Check # _______ or Visa/MasterCard # ______________________________________ Exp. Date____/____Signature of Cardholder x:_______________________________________________
Mail completed order
form to:
Sigma Beta Delta, PO Box 210570, St. Louis, MO 63121-0570
Any questions please call (314) 516-4723