Request form with payment must be received before we can ship an order.

Parish/Diocese Using/Receiving Bands: Purpose of Bands/Date of Use:

Ship to: Name Address 1 Address 2 City, State Zip

Bands are distributed in bundles of 100 -- each bundle of 100 bands costs $34.00 Number of Bundles of 100 bands Subtotal (#bundles x $34) Shipping Cost (see table below) Total Shipping and Handling 100 - 500 bands 600-1200 bands 1300-1800 bands 1800-2500 bands

$5 $10 $15 $20

*Additional Cost for Expidited Shiping

INTERNAL USE ONLY Date Order Received: Check Processed: Order Shipped Date Shipping Method and Tracking:

Checks should be made out to: DFMS Memo Line: OGR - ONE Episcopalian Mail to: Episcopal Church OGR ATTN: ONE Episcopalian 110 Maryland Ave., NE Ste 309 Washington, DC 20002

ONE Band Form -

Parish/Diocese Using/Receiving Bands: Purpose of Bands/Date of Use: Ship to: Name. Address 1. Address 2. City, State Zip. Bands are distributed in bundles of ...

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