Girl Scout Patch Order Form

Patch Application and Order Form

Date: ____/____/____


	Ship Patches To: Name: ___________________________________ Address: _________________________________ Address: _________________________________ City: _____________________________________ State: _________ Post/Zip Code: ____________ Country: _________________________________ Civilian Addresses Only. APO Address will delay shipment.

Troop Number: _____________________________

Neighborhood or Council:_____________________

Leader's Name: _____________________________

Contact Email: ______________________________
Required to Process Order

Telephone #: ______________________________
Include Country Code for Dialing

Fax #: ___________________________________

*Patch Name*	*Quantity*	Unit Price	*Extended Price*	*Total*
American History in London		£ 4.00 each
Central London Neighborhood		£ 4.00 each
Juliette Low		£ 4.00 each
Children's Literature		£4.00 each
London Transport		£ 4.00 each
Travel the British Isles		£ 4.00 each

Checks drawn in GBP Sterling only. We do not accept cash or checks in US Dollars.
We do not accept credit cards.

Balance Due

£ GBP

Mail Form and Check To:

Central London Neighborhood Girl Scouts
c/o The American School in London
Attn: Patch Program Coordinator
One Waverley Place
London, UK NW8 0NP

Leader's Signature (Required for Processing):
________________________________________________

The Central London Neighborhood Girl Scouts welcomes and appreciates suggestions for new Patches. We are always interested in new sites to visit for the Children's Literature and American History patches. Please include the site location and details on a separate sheet of paper. Thank you.