Honors of Epsilon Pi Jewelry Pre-Pay Form

This form should be used by petitioning groups wishing to pre-pay for anticipated Honors of Epsilon Pi jewelry. Pre-paid jewelry will be available for pick up on Friday, June 26, following the Honors of Epsilon Pi Service. Jewelry not picked up will be mailed to the petitioning group in July.

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This field is for validation purposes and should be left unchanged.

Petitioning Group Name (i.e. Alpha Chapter, Raleigh Alumnae Chapter)

Petitioning Group Representative (i.e. person filling out this form)

Contact Information (Individual Completing Order)

First Name(Required)

Maiden Name (if applicable)

Last Name(Required)

Initiating Chapter

Phone

Email(Required)

Will your group have a representative attending International Convention in June?(Required)

Yes

Unsure

I understand that if my group does not send a representative to International Convention, all pre-paid jewelry will be mailed to the person completing this form.(Required)

I understand

I understand that any Honors of Epsilon Pi jewelry that is paid for but not needed cannot be returned to International Headquarters. The group should keep the jewelry in its inventory for future use.(Required)

I understand.

Total Amount Due

Please enter the amount from the pre-payment email you received:

Total

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment Information

Credit Card Information(Required)

Alumnae Jewelry Order

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Honors of Epsilon Pi Jewelry Pre-Pay Form

Contact Information (Individual Completing Order)

Total Amount Due

Payment Information

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