A L P H A P H I A L P H A F R A T E R N I T Y , I N C . ® | PO BOX 405478, ATLANTA, GA 30384-5478 Chapter Charter Order Form Directions: 1.
Member should fill out form completely.
2.
Make check or money order payable to Alpha Phi Alpha Fraternity, Incorporated.
3.
Mail payments to PO Box 405478, Atlanta, GA 30384-5478 or email forms@apa1906.net for credit card payments.
4.
Keep a copy for your records.
5.
Please do not forget to include shipping and handling fees.
6.
A receipt will be sent upon request.
BILLING/SHIPPING INFORMATION Chapter Name:
Key Number :
Address: City, State Zip: Home Telephone:
Email Address:
C/O: Quantity
Description Duplicate Chapter Charter
Unit Price
Total
1. Please attach to this order form the full name of each
Subtotal Shipping Balance Due CREDIT CARD PURCHASES VISA, AMEX AND MASTERCARD NAME AS IT APPEARS ON CARD
TYPE: NUMBER: EXP. DATE:
PLEASE NOTE
$240.00
$10.00
charter member and the chapter founding date. Some chapters do not have this information on file and it will be needed to process the order.
2. If the signatures are not of file for the administration of the General President when your chapter was founded, the signatures of the current Administration will be used. 3. The charter will be shipped to the above address within 2-4 weeks after payment is processed. 4. Payment must be sent with the order form. 5. If you fail to submit the charter information and it is not on file at the Corporate Office, it will delay the processing of this order.
SIGNATURE: DATE:
FOR OFFICE USE ONLY TRANSACTION DATE: _______________________________
Phone: 1.800.373.3089 Email: forms@apa1906.net
PROCESSED BY:
_______________________________
DATE PROCESSED:
_______________________________
REMITTANCE NO:
_______________________________
Page 1 of 1 original.doc updated 08/11/2009