The Broad Ripple Gazette

Collector Pin Order Form

The Broad Ripple Cloisonné Collector Pins are available at many locations throughout the Broad Ripple area. If you live outside of the area and wish to receive mail delivery, please fill out this form and return with payment.

Date _____________________

Name	__________________________________________
Address	__________________________________________
City, State, Zip	__________________________________________
phone	__________________________________________
email	__________________________________________

Pin Style	Per pin	Total
__ BRV Duck 001	$4.50
__ Canal 002	$4.50
__ BR Gazette 003	$4.50
__ Patio sign 004	$4.50
	SHIPPING/HANDLING	$3.50
	SUBTOTAL
	TAX (Indiana residents 6%)
	TOTAL

Please mail with payment to:

The Broad Ripple Gazette

PO Box 55973

Indianapolis, IN 46205

Prices are subject to change without notice

Indiana sales tax is calculated on amount including shipping.

Questions? info@BroadRippleGazette.com (317) 508-6634