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"Specialty" and "Picture" Button Order Form
When you order picture buttons, please send a photo for EACH individual button. The photo must be at least 2 ^3/4" x 2 ^3/4" or larger. If you do not have extra copies, the club can produce a scanned copy for a 50 cent fee. There may be a slight loss in the quality of photo with scanned copies.
If you are ready to order buttons, please complete the order form below.
IMPORTANT! - use the TAB key to move through the form, do not hit the enter button until ready to submit.
PARENT FIRST NAME(S)			PARENTS LAST NAME

*Please indicate both parent's first names if this applies to your family*
PARENT STREET ADDRESS - include apt or unit number

PARENT CITY, STATE, ZIP

HOME PHONE		OFFICE PHONE		FAX

PARENT EMAIL ADDRESS

Select your button type in the column labeled "Button Type". If choosing specialty buttons, you'll need to select the specific wording in the columns at the right. If requesting picture buttons or Army/Navy buttons, there is no need to select specific wording. If ordering only one button please leave the remaining numbered button rows with "no selection".
Button Number	Quantity	Button Type	Proud family*	Class Year**	Navy Sport***
1
2
3
4

Buttons are $3.00 each and remember, there is an additional 50 cent charge for each photo scanned.
Total number of buttons ordered	Amount due # Buttons X $3.00	Additional fee for scanned photos	Total Amount Due

SPECIAL INSTRUCTIONS (Indicate here any questions or special requests)

Please click the submit button below, then print 2 copies, one for your records and one to mail with your check made payable to USNA Parents Club of NJ to: Remember to include photo(s) for picture buttons.
Tom Ursetti 36 Ruth Place North Haledon, NJ 07508 (973) 238-1801
Questions: Call them at (973) 238-1801 or e-mail to: Plan931@aol.com