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St. John's Lodge 51 - 175 Year Anniversary Commemorative Coin Order Form
Please complete the information below and answer each question. If you do not want to purchase a specific coin listed put 0 as the answer.
Orders are due by May 15, 2024
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First Name
*
Your answer
Last Name
*
Your answer
Phone Number
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Your answer
Email Address
*
Your answer
Home Address
Your answer
1.5 Inch Bronze Coin - $10 each
How many
1.5 Inch Bronze Coins
do you want to order?
*
Your answer
2 Inch Colored Coin $20 each
How many
2 Inch Colored Coins
do you want to order?
*
Your answer
1.5 Inch
Silver
Coin $120
All Silver Coins orders must be prepaid before the order is placed.
How many
1.5 Inch Silver Coins
do you want to order?
*
Your answer
I understand that I am obligated to pay for the order above and will pay.
Payment options
1. Cash to Roger Jacobsen, Mark Allred, or Victor Rule.
2. Zelle using treasurer@saintjohns51.com
3. PayPal using treasurer@saintjohns51.com if asked the name attached to the account is Hiram Abiff
Thank you for supporting St. John's Lodge 51
*
Yes, I will pay using the using the payment options above
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