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Lopez Mug Order Form

Fill out the information below to reserve/order your Lopez mug(s).

Name:
Address:
Address:
City, State, Zip:
Phone:
e-mail:

	Qty. @ $20.00 each + S/H
Select other years you would be interested in purchasing and quantity you would purchase if they become available:	2001 Qty. 2002 Qty. 2003 Qty. 2004 Qty. 2005 Qty. 2006 Qty. 2007 Qty. 2008 Qty. 2009 Qty. 2010 Qty. 2011 Qty. 2012 Qty.

Once your order is received we will e-mail you a total with shipping charges included. You may then send a check, payable to Robert McGuire, for the total amount to:

Robert McGuire
Box 224
Lopez, PA 18628

You may also pick up your order and save the shipping charges and pay at the time of pickup.

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