LGG Chapter Mouse Pad Purchase Form

Quick Purchase Mouse Pad Form

Members of Lambda Gamma Gamma Chapter can purchase a chapter mouse pad in either OLD GOLD colored mat or ROYAL PURPLE colored mat.

Please complete the form below to purchase your mouse pad (NOTE: New members or transfers to LGG receive one (1) free initial mouse pad).

LGG Old Gold Mat Mouse Pad LGG Royal Purple Mat Mouse Pad

“OLD GOLD 35th Anniversary Mat” “ROYAL PURPLE Mat”

If you have problems or issues with your order, please email ‘onlinesales@capitalregionques.org‘ or ‘helpdesk@capitalregionques.org‘.

Personal & Mailing Information

Enter personal information & shipping/mailing information.

Name(Required)

First Last

Dogtag?

Enter dogtag information (e.g. 9-95-Tau Gamma Gamma)

Phone/Mobile Number:(Required)

Enter your phone/mobile number.

Email(Required)

Enter Email Confirm Email

Enter Email Address (chapter email or personal email address).

Mailing Address(Required)

Street Address City State ZIP Code

Enter your mailing address to have mouse pad shipped to.

Select Mouse Pad & Payment:

Please select:(Required)

Select only one checkbox option below:

New or transferring Brother to LGG?

Current LGG member and requesting new or more mouse pads?

LGG Purple Mat Mouse Pad

Price: $5.75

Lambda Gamma Gamma Chapter Purple Mouse Pad.

LGG Gold Mat Mouse Pad

Price: $5.75

Lambda Gamma Gamma Chapter Gold Mouse Pad.

Select Mouse Pad(Required)

Select which mouse pad that you would prefer; "Old Gold Mat" or "Royal Purple Mat".

Pack-n-Ship Costs

Packing & shipping costs. Domestic US Postal . First class mail/flat.

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Enter credit card payment information. (NOTE: DO NOT HIT THE PAY BUTTON TWICE OR DOUBLE-CLICK! IF YOU DO YOU WILL BE BILLED TWICE. SINGLE-CLICK THE BUTTON!)

LGG Chapter Mouse Pad Purchase Form

Quick Purchase Mouse Pad Form

Personal & Mailing Information

Select Mouse Pad & Payment:

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