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 303845478 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 303845478 or fax to (301)2069789 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:
Key Number :
Email Address:
Quantity
Description
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:
EXP. DATE:
PLEASE NOTE 1. Please 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 be needed to process the order. 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 24 weeks after payment is processed. 4. Payment must be sent with the order form. 5. If you fail to submit the charter information and it is not
SIGNATURE: DATE: FOR OFFICE USE ONLY TRANSACTION DATE: _______________________________ PROCESSED BY:
Phone: 1.800.373.3089 | Fax: 301.206.9789 Email: forms@apa1906.net
_______________________________
DATE PROCESSED: _______________________________
Page 1 of 1 REMITTANCE NO: _______________________________ 110920034223-1c220a4eacd5493c9726255e40c8944d.file updated 08/11/2009