chapter_duplicate_charter_order_form

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A L P H A P H I A L P H A F R AT E R N I T Y , I N C .

®

| PO BOX 405478, ATLANTA, GA 30384-5478

Chapter Charter Order Form

Directions: 1.

Member should fill out form completely.

2.

Make check or money order payable to Alpha Phi Alpha Fraternity, Incorporated.

3.

Mail payments to PO Box 405478, Atlanta, GA 30384-5478 or email forms@apa1906.net for credit card payments.

4.

Keep a copy for your records.

5.

Please do not forget to include shipping and handling fees.

6.

A receipt will be sent upon request.

BILLING/SHIPPING INFORMATION Chapter Name:

Address:

City, State Zip:

Home Telephone:

C/O:

Quantity

Description

Key Number :

Email Address:

Unit Price

Duplicate Chapter Charter

Total

$240.00

Subtotal

Shipping

$10.00

Balance Due

CREDIT CARD PURCHASES VISA, AMEX AND MASTERCARD NAME AS IT APPEARS ON CARD

TYPE:

NUMBER:

PLEASE NOTE

1. Please EXP. DATE:

attach to this order form the full name of each       charter member and the chapter founding date. Some chapters do not have this information on file and it will SIGNATURE: be needed to process the order. DATE:

2. If the signatures are not of file for the administration of the General President when your chapter was founded, the signatures of the current Administration will be used. 3. The charter will be shipped to the above address within 2-4 weeks after payment is processed. 4. Payment must be sent with the order form. Phone: 1.800.373.3089 5. Ifforms@apa1906.net you fail to submit the charter information and it is not Email:

on file at the Corporate Office, it will delay the processing of this order.

Page 1 of 2 tmplPwvPI updated 08/11/2009


A L P H A P H I A L P H A F R AT E R N I T Y , I N C .

| PO BOX 405478, ATLANTA, GA 30384-5478

Chapter Charter Order Form

FOR OFFICE USE ONLY TRANSACTION DATE: _______________________________ PROCESSED BY:

_______________________________

DATE PROCESSED:

_______________________________

REMITTANCE NO:

_______________________________

Phone: 1.800.373.3089 Email: forms@apa1906.net

Page 2 of 2 tmplPwvPI updated 08/11/2009


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