
Name________________________ Mug Number Requested_____
Address________________________________
_______________________________________
Phone Number__________________________
E-mail Address__________________________
Quantity of Mugs Ordered________________
Please include $2.50 per mug for shipping_________________
Total Amount___________________________
As the purchaser of this mug, you have the first option to buy this same numbered mug next year. Do you want to be notified when the next Fredericktown Limited Edition Mug is available? YES______ NO______