Miners Club Supplies Order Request Form
To order Miners Club supplies, simply complete the information below and click on "submit order". Upon receipt of your order, billing and shipping schedule information will be sent to you. All proceeds from purchases of these materials go to support Miners Club. * = Required Information
Contact Information
Organization:*
Contact Person:*
Address:*
xxx Street
City, State, Zip
Phone:* (xxx)xxx-xxxx Extension:
Fax: (xxx)xxx-xxxx Extension:
E-Mail:* xxx@xxxxx.com
Information about your use of Miners Club supplies
Type of Use:
  If "other" please describe here:
Location of use: Same info as above Different info below
Place Name:
Address:
xxx Street
City, State, Zip
Phone: (xxx)xxx-xxxx Extension:
Survey: Please explain how you found out about Miners Club:
Miners Club Supplies Request
Select Product and Quantities below and click on "submit order" button.
Miners Club T-Shirt $7.50 each
Child Small: (qtty.)
Child Medium: (qtty.)
Child Large: (qtty.)
Child X-Large: (qtty.)
Adult Size: (qtty.)
  
 Miners Club Cap $9.00 each (One size fits all)
(qtty.)
Miners Book 1 Nuggets $2.00Miners Book 1
Nuggets
$2.00 each.
(qtty.)		 Miners Book 1 Nuggets - SpanishMiners Book 1
Nuggets
Spanish Version
$2.00 each.
(qtty.)		 Miners Book 2 Gemstones $2.00Miners Book 2
Gemstones
$2.00 each.
(qtty.)
  Miners Book 3 Rubies $2.00
Miners Book 3
Rubies
$2.00 each.
(qtty.)		   Miners Book 4 Diamonds $2.00
Miners Book 4
Diamonds
$2.00 each.
(qtty.)		 Miners Book 5 Emeralds $2.00Miners Book 5
Emeralds
$2.00 each.
(qtty.)
Miners Book 6 Amethyst $2.00Miners Book 6
Amethyst
$2.00 each.
(qtty.)		 Miners Book 7 Sapphires $2.00Miners Book 7
Sapphires
$2.00 each.
(qtty.)		 Miners Book 7 Sapphires $2.00Miners Book 8
Jasper
$2.00 each.
(qtty.)
Miners Trophy w/one stone $5.00Miners Trophy
with Nuggets
Stone
$5.00 each.
(qtty.)		    
Other Trophy Stones $1.00 ea.Miners Trophy Stones $1.00 each.
Book 1 Nuggets Stone: (qtty.)
Book 2 Gemstones Stone: (qtty.)
Book 3 Rubies Stone: (qtty.)
Book 4 Diamonds Stone: (qtty.)
Book 5 Emeralds Stone: (qtty.)
Book 6 Amethyst Stone: (qtty.)
Book 7 Sapphires Stone: (qtty.)
Book 8 Jasper Stone: (qtty.)
Submit your Miners Club Supplies Order Request
To submit your order, simply click on the "Submit Order" button below. Upon receipt of your order, billing and shipping schedule information will be sent to you. All proceeds from purchases of these materials go to support Miners Club.

Thank you for supporting Miners Clubs