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VFW Department of California 9136 Elk Grove Blvd. Suite 100 Elk Grove CA 95624 Phone 916 509-8712 Fax 916 509-8720 BUDDY POPPY ORDER FORM Post No. SHIP TO District No. BUDDY POPPIES CANNOT BE SHIPPED TO A P. O. BOX LIST YOUR STREET ADDRESS ONLY Individual s Name Street Address City Is this a Residence or a Post address Circle One QUANTITY UNIT PRICE Buddy Poppies minimum of 500 100. 00 per 1 000 TOTAL Note All orders of Cans and Boards need to be made directly from National Emblem and Supply Signed Name Title Daytime Phone Number Poppy s may be paid from the proceeds of your donations collected. The QM may remit the amount due without floor action at the time the receipts are counted. All poppies ordered prior to November 30th must be paid by December 31st. O. BOX LIST YOUR STREET ADDRESS ONLY Individual s Name Street Address City Is this a Residence or a Post address Circle One QUANTITY UNIT PRICE Buddy Poppies minimum of 500 100. 00 per 1 000 TOTAL Note All orders of Cans and Boards need to be made directly from National Emblem and Supply Signed Name Title Daytime Phone Number Poppy s may be paid from the proceeds of your donations collected* The QM may remit the amount due without floor action at the time the receipts are counted* All poppies ordered prior to November 30th must be paid by December 31st. All orders received after January 1st must be paid by May 15th. CREDIT CARD EXPIRATION DATE Name as it appears on the credit card Visa--M/C AE Other Circle one Signature NOTE WHILE NOT REQUIRED POSTS ARE ENCOURAGED TO PROVIDE A CHECK FOR PAYMENT WITH THE ORDER FORM. 00 per 1 000 TOTAL Note All orders of Cans and Boards need to be made directly from National Emblem and Supply Signed Name Title Daytime Phone Number Poppy s may be paid from the proceeds of your donations collected* The QM may remit the amount due without floor action at the time the receipts are counted* All poppies ordered prior to November 30th must be paid by December 31st. All orders received after January 1st must be paid by May 15th. CREDIT CARD EXPIRATION DATE Name as it appears on the credit card Visa--M/C AE Other Circle one Signature NOTE WHILE NOT REQUIRED POSTS ARE ENCOURAGED TO PROVIDE A CHECK FOR PAYMENT WITH THE ORDER FORM.

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