Veteran Banner Project Order Form Veteran Banner Project Full Name*Address* Street Address Address Line 2 City Province ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Post Code Email* Enter Email Confirm Email PhoneVeteran Name* First Last Birth Year*Year of Death (if applicable)*Place of Birth (Optional)Country of Military Service*Branch of Services Regiment (optional)Time Period Served (Specific years, or simply the name of the war)*Veteran's Connection to the Bayfield Area*Veteran Photo Supplied (please indicate)* Hard Copy I consent to the information I have given about the Veteran (above) being preserved and made available to the public and historical researchers.* Yes No Select Payment Method* Online Card Payments E-Transfer After submitting this form please send your E-Transfer for the full amount to blc.etransfer@gmail.comVeteran Memo rial Banner(s) Quantity* Price: $ 300.00 CAD Quantity Total $ 0.00 CAD Card Details DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name
