EmailMe Form - Chi Alpha Epsilon Merchandise Order Form

Advisor's Name

Prefix First Last

Institution Name

Chapter

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Shipping Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email

Chi Alpha Epsilon Ledger: $165.00
Total Requested:

Full Color Chapter Banner: $335.00
Total Requested:

Banner Color

Blue

White

XAE Decal: $2.00
Total Requested:

10k Gold Plate Key: $43.00
Total Requested:

Key Type

Charm

10k Gold Plate Key with Jewel: $50.00
Total Requested:

Key Type

Charm

10k Gold Plate Key Necklace: $46.00
Total Requested:

Replacement Honor Cord: $25.00
Total Requested:

XAE Leadership Training Manual: $15.00
Total Requested:

XAE Basic watch: $30.00
Total Requested:

XAE Unisex Watch: $43.00
Total Requested:

XAE Special Edition Watches (The Founder's Choice) $80.00
Total Requested:

XAE Special Edition Watches (Swiss Movement): $90.00
Total Requested:

XAE Key Ring: $21.00
Total Requested:

Blue Lucite Paper Weight: $18.00
Total Requested:

Marble Paper Weight: $30.00
Total Requested:

Award Plaque: $43.00
Total Requested:

Tankard: $33.00
Total Requested:

10k Gold Plate Jewel Bars with chain: $10.00
Total Requested:

Chapter Reinstatement Fee (Requires approval of President or Founding Director): $165.00
Total Requested:

Item(s) Sub-Total

$ Dollars . Cents

Grand Total

$ Dollars . Cents

Add 9% for Shipping and Handling. An invoice will be emailed to the email address provided above.