Magbase
2710 Duane Drive
Meridian, Idaho 83646

NAME_________________________________________               DATE______________

ADDRESS_____________________________________________________________________

CITY______________________________________ STATE__________ ZIP ______________

CONTACT PHONE NUMBER__________________ EMAIL__________________________
ITEM QUANITY:
ARMY                                                                                       Beretta 92/96

PIN  $12.49 _________ ADHESIVE BACK  $12.49 ________   MAGBASE  $39.99 ________

NAVY                                                                                      Beretta 92/96

PIN  $12.49 _________ ADHESIVE BACK  $12.49 ________   MAGBASE  $39.99 ________                                                            
 AIR FORCE                                                                           Beretta 92/96
PIN  $12.49 _________ ADHESIVE BACK  $12.49 ________   MAGBASE  $39.99 ________

MARINE CORPS                                                                    Beretta 92/96
PIN  $12.49 _________ ADHESIVE BACK  $12.49 ________   MAGBASE  $39.99 ________

COAST GUARD                                                                      Beretta 92/96
PIN  $12.49 _________ ADHESIVE BACK  $12.49 ________   MAGBASE  $39.99 ________

SUB
TOTAL:     __________                   +                       _________           +                     ________

SHIPPING & HANDELING ------------------------------------------------------------------  $2.95

TOTAL____________

*please enclose check or money order