OFFICIAL SHIP’S STORE
ORDER FORM	

Item	DD/
DDE	Size	Qty	Unit Price	Line Total	

 						

						

						
Shipping Charges					$	 	
				Total	$		

For shipping charges, email completed 
order form to Geoffrey Bender:
gbenderftg2@hotmail.com

After shipping charges are calculated the order form will be emailed back to you for payment.

Name            
Address           
City/State       
Zip            
Make check payable to: USS Basilone Assoc. 
Send form and check to: 
Fred Gehrisch 
5640 Whistling Cove Rd 
Gainesville, GA 30504 
Note Place: Ships Store in Check Memo 	
	
Signature