Gatesburg Bicentennial Items Order Form

To reserve your order for pickup at the bicentennial, please complete attached form and forward with payment to Diane Snyder, 2115 W. Gatesburg Rd., Warriors Mark, PA  16877.  Email address:  dxs7@psu.edu

Make checks for payable to: Diane Snyder

To have items shipped, complete order form and forward to address above.  Diane will respond with payment due plus shipping costs to be paid prior to shipping.

Name ________________________________________________

Address ______________________________________________

Phone # ______________________________________________

Email address _________________________________________

Item                                          Qty                               Amt

                                                                             (sales tax included)

_______________              _________                     ___________

_______________              _________                     ___________

_______________              _________                     ___________

_______________              _________                     ___________

_______________              _________                     ___________

    Total ___________       

When ordering mugs – please state which design

All pottery items are microwave and dishwasher safe!!