Form Center

2. OrderForm
   Select the quantity desired of each item below. Prices do not include tax.
4. 
5. Niles Flag Pin
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6. Pin - Quantity:
   -- Select One --012345
7. @ $10.00 per item
11. 
12. Niles Pen
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13. Pen - Quantity:
    -- Select One --012345
14. @ $10.00 per item
18. 
19. Niles "Diner" Coffee Mug
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20. Mug - Quantity:
    -- Select One --01234
21. @ $10.00 per item
25. 
26. Niles Logo Golf Ball
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27. Golf Ball - Quantity:
    -- Select One --012345
28. @ $5.00 per item
32. 
33. Coaster with Leaning Tower Concept Art (single individual coaster)
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34. Coaster - Quantity:
    -- Select One --0123
35. @ $5.00 per coaster
39. 
40. Coasters with Leaning Tower Concept Art (boxed set of 4 coasters)
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41. Boxed Coaster Set - Quantity:
    -- Select One --012
42. @ $15.00 per boxed set
46. Contact Information
    (Required)
48. First Name*
49. Last Name*
51. House Number*
52. Address Street*
53. Unit
55. City
56. State
58. Phone Number*
60. Please Note
    This is only a reservation. Please add up the items requested to estimate your order total. Sales tax is included in the item prices listed on this page. No payment will be collected until you pick up your order at Village Hall, 1000 Civic Center Drive. Cash, checks, and credit cards are accepted for payment.
62. Please Check*

    1. I understand and agree to the conditions of the reservation system.
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit Submit and Print

* indicates a required field