USS America Order Form
		Item	Cost	Qnty	Ext
		----------------------------
		Zippo	$24.95	____	____
		Coin	$12.00	____	____
		Case	$6.00	____	____
		Patch	$10.95	____	____
		SubTtl			____
		FL ST	6.5%		____
		Shipping		$4.60
		Total			____

		Ship to:
		Name:	_____________________
		Address:_____________________
		City:	_____________________
		State:	_____________________
		Zip:	_____________________

		Phone:	_____________________
		E-Mail:	_____________________

		Florida residents, please add 6.5% sales tax.
		Mail this completed form with your check to:

		USS America Museum Foundation
		10 Summit Avenue
		Butler NJ 07405

		Please allow 2 to 3 weeks for selivery.
		Thank you for your order and support.