IRKPA Order Form

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Note, you will not be charged the shipping on memberships.

Michigan residents will be charged 6% sales tax on merchandise, shipping and handling.

If you would like your order shipped USPS Priority Mail, please indicate
that in the "special instructions" box. An additional $4.00
will be added to your order." Thanks!

SHADED FIELDS are required information.
Item Price Each Description Quantity Subtotal
Shipping Address:
E-Mail: 
Name(First & Last):
Street:
 City:  State:  Zip: 
  Phone:   Fax: 
(If Different) Billing Address:
Street:
 City:  State:  Zip: 
Credit Card Information: 
Visa Mastercard  Discover 
Name on Card: 
Number:   Exp. Date: 
Special Instructions: