Masonic America 250 Flag Program Order Form

Masonic America 250 Flag Program
Order Form

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Limit one flag per order form.
If you wish to place another order, you must complete a separate form.

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At this time, we only are accepting credit cards from or shipping orders to US States, US Territories, and FPO/APO Addresses. Any orders from outside those locations listed here will be canceled.

We apologize for any inconvenience.

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Where do you reside?
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At this time, we only are accepting orders from and shipping to US States, US Territories, and FPO/APO Addresses.

We sincerely apologize for any inconvenience.

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Contact Information
Your Name

First NameLast NameSuffix
Your Email Address

Confirmation EmailYour payment receipt & acknowledgment email will be sent to this address.
Are you a Scottish Rite Freemason?
Scottish Rite Degree
Valley
Orient
Name of Person (or Organization) for Whom This Flag Is Being Flown
Please enter name EXACTLY as you would like it to appear on the certificate.

Payment Information
Program Code

Your Order

Folded Flag and Certificate (limit one flag per form)

$250.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Shipping Information
Where are you shipping the flag and certificate?
Address - US State / US Territory

Street Address

Street Address Line 2

CityState

Zip Code
Address Line 1
Please limit entry to 30 characters or fewer.
Address Line 2
Please limit entry to 30 characters or fewer.
Address Line 3
Please limit entry to 30 characters or fewer.
Address Line 4
Please limit entry to 30 characters or fewer.

Please Review Your Order.

Please use the "Back" button below to correct any errors.

Your Name:

{yourName}

Your Email:

{yourEmail25}

Name as It Should Appear on the Certificate:

{nameOf}

Order Total (USD):

$250.00

Shipping Address:

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{address}{addressLine}
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{addressLine67}
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