Confederate Masonic Ring Order Form

Please fill out the form below completely. It will be sent when you click "Submit Form". Please only click submit once. A confirmation will be displayed following the submission.

Contact Information:

Full Name (include middle initial)
Street Address
City, State, Zip
Apartment Number
Country

Area Code and Phone Number

SELECT RING SIZE

Please Type Ring Size Below for Verificaton
Ring Size




EMAIL ADDRESS

To pay by check or money order, please print out this page and mail it to:

Michael Duminiak
Commander - PA Division
P.O. Box 75
Port Matilda, PA 16870-0075

Please make your check or money order payable to Michael Duminiak and write 'Confederate Masonic Ring' in the memo line.

If you wish to pay with a credit card, please fill in the information below and then click 'Submit Form'. The payment will be processed by Paypal.

Credit Card (Visa/MC/AMEX Only)
Cardholder's Name
Card Number
(no dashes)
Expiration Date (use this format 01/03)

Please reference ORDER DATE when checking on ring.
Please do not call and check until approx. 5 weeks after ordering as it slows things down.

Comment Field