Name __________________________________________________________________

Address ________________________________________________________________

City __________________________________   State _________   Zip _____________

Telephone ____________________________

Number of pins @ $3.00 each ______________  Total ___________________________

        Plus shipping:         $15.00  or  under            $2.50 ___________

                                   $15.01  to  $30.00          $5.00 ___________

                                   $30.01  or  more             $6.50 ___________         

Mail this form to:  PDG Donald E. Davison

                              3406 Seventh Ave., Beaver Falls, PA 15010-3520

                             Telephone:  724-846-1337                email:  ddavison20@comcast.net