Name:________________________________________________

Address:_______________________________________________

Telephone:_____________________

I would Like to Buy _________ POENB Magnets at $2.00 each

Enclosed is my payment (checks Payable to POENB) of $______________

Please Leave this form at the POENB box located on the Sign Board in The Fire House Parking Area  

                or

mail to P.O. Box 124, Northport NY 11768