Division of Historic Preservation and Archaeology
ORDER FOR ARCHAEOLOGY MONTH T-SHIRTS
State Form 50253 (R3/6-05)
402 W. Washington St., W274, Indianapolis, IN 46204-2739 317-232-1646; 317-232-0693; [email protected]
Form Approved by State Board of Accounts, 2005
Please PRINT legibly.
Name
Telephone Number
(
Address (Number and Street/Rural Route, NO P.O. Box)
)
City, State, Zip Code
QUANTITIES LIMITED. NOT AVAILABLE FOR RE-SALE.
Quantity Size Small Medium Large X-Large XX-Large Unit Price $5.00 $5.00 $5.00 $5.00 $5.00 $ $ $ $ $ Sub-Total
Shipping & Handling (CANNOT SHIP TO PO BOX) 1-3 Shirts 4-6 Shirts 7-10 Shirts 11-15 Shirts 16 -25 Shirts $4.00 $5.00 $6.00 $7.00 $8.00
Merchandise Total $ + Shipping & Handling $ = TOTAL AMOUNT DUE $
Orders exceeding 25 shirts will be subject to the shipping and handling charges as stated above. Example: An order for 55 shirts $8.00 +$8.00 + $5.00 = $21.00
ENCLOSE CHECK OR MONEY ORDER PAYABLE TO: DEPARTMENT OF NATURAL RESOURCES PLEASE DO NOT SEND CASH. SORRY NO COD'S. ALL RETURNED CHECKS ARE SUBJECT TO A $20 RETURN CHECK FEE.
These t-shirts were financed in part with federal funds from the U.S. Department of the Interior, National Park Service, as administered by the Indiana Department of Natural Resources, Division of Historic Preservation and Archaeology. However, the contents and opinions of this product do not necessarily reflect the views or policies of the Department of the Interior, nor does the mention of trade names or commercial products constitute endorsement or recommendation by the U.S. Department of the Interior. Under Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, the U.S. Department of the Interior prohibits discrimination on the basis of race, color, national origin, or disability in its federally assisted programs. If you believe that you have been discriminated against in any program activity, or facility as described above, or if you desire further information, please write to: Office of Equal Opportunity, National Park Service, 1849 C Street, NW, Washington, D.C. 20240.
FOR OFFICE USE ONLY
Date Processed $ Amount Received Check #___________________ Money Order #_____________ Cash Staff Initials