Traditional Catholic Goods

P.O. Box 15331

Loves Park, IL 61132-5331

MAIL ORDER FORM                      (For Non-internet and check orders only)

Bill to:                                                 Ship to: (check If same as bill to) o

Last Name:        _________________________    Last Name:    _________________________        

First Name:       _________________________     First Name:    _________________________        

Address:            _________________________         Address:         _________________________

City/State:         _________________________         City/State:      _________________________

Zip:                    ____________________                      Zip:                 ____________________

Email:                _______________________   

Payment:       oCheck      oVisa       oMasterCard      oDiscover

CC#  ___ ___ ___ ___  ___ ___ ___ ___  ___ ___ ___ ___  ___ ___ ___ ___      Exp. _____ _____

Order Value (in black) - Freight Cost (in red): 

$.01-$20.00 = $4.95; $20.01-$50.00 = $6.95; $50.01-$100.00 =$8.95  $100.01-$150.00 = $12.95 

$150.00 +  FREE

             .