Order RainbowCoin

Memberships

****** SHIP TO ***

NAME:          _______________________________

Street:________________________________ __________

City: ______________State  _______Zip Code:____________

Email Address: ___________________________
Phone:   (_____)______________Fax:(_____)_____________

Member #____Name___________E-mail___________________

Membership w/Hand made Silver Color Flag @ $14.00 = $        .00

Membership w/Bronze with Enamel Color Flag @ $14.00 = $ __   .00

Total  Silver & Bronze Rainbowcoin  Memberships      _________

Total Amount for ___Memberships   $               .00

Memberships may be paid by Check, Cash or Money Order

All normal charges including Shipping (1st Class U.S. Mail) are included in the above Amounts.   Print this Form or Copy Format as close as possible & Mail To:

RainbowCoin Membership

6911 Greenhill Place

Tampa, Fl. 33617-1720

Cash & Money Orders allow about a week or 10 days turn around time.

Checks allow 14 -23 days turn around time.

Please Note:  RainbowCoin Maintains the Official Membership Roster, The roster Includes your member number, first and last name,  your city, state, country and e-mail address at YOUR discretion. So let us know If you do not want your name on the official roster or not.

Don't Bounce around, Let us Know

Mail To:

RainbowCoin Membership

6911 Greenhill Place

Tampa, Fl. 33617-1720

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