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2012-2013 Pins and Quests Order Form

This online submission form will enable you to request
Pins and Quests for new Associate Members.

When determining how many of each you are requesting...
Remember your chapter/colony will be billed at the end of the year for unused items that are not returned by May 1, 2012. For example, if you order 30 of each and only associate 20 new AM's, you will be billed for the extra 10 Pins ($3 each) and 10 Quests ($12 each) if they are not returned to HQ by May 1st.

Only one submission per chapter/colony, please.

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Chapter Name:

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Contact information

Name and Roll #:

Title:

Email Address:

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Shipping Address (No PO Boxes)

Name: *

Officer Position:

Address: *

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

Phone Number: *

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What is your chapter/colony's 2012-2013 Initiation Goal?

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How many of each item are you requesting?

Pins:

Quests:

Question Title

Please indicate your choice of shipping and handling options:

No Charge Shipping via United States Post Office - Chapter/colony assumes all responsibility for missing items and will be charged to replace any items not received.

$9.95 Shipping Charge via UPS (billed to your chapter/colony account) - Missing items will be replaced at no cost to the chapter/colony.

Pressing the "Submit" button below will send your request to Theta Xi Fraternity Headquarters.

<fontsize=+1>NOTE: Because the Pins and the Quests are shipped from different locations,
you will receive them in separate shipments.

Contact Amy at amy@thetaxi.org if you do not receive these items in two weeks.