United Daughters of the Confederacy®
North Carolina Division
Certificate Order Form
Name________________________________________________________________________________________
As you wish it to appear on the certificate
Great Grandfather's Name__________________________________________________ _____________________
Regiment___________________________________Company_________________________State_____________
ENCLOSE YOUR CHECK FOR $7.00 WHICH WILL COVER COST OF CERTIFICATE, HANDLING AND POSTAGE. MAKE THE CHECK PAYABLE TO "TREASURER, NC GGC". MAIL TO MARGARET SINK, NC GGC TREASURER, 706 PRESWICK DRIVE, NASHVILLE, NC 27856-1682.
NAME______________________________________________________________________________________
CITY_______________________________________STATE_____________ ZIP+4__________
DATE________________
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FOR TREASURER'S USE ONLY
Date Certificate Form Received_______________________
Date Certificate Ordered_____________________________
Paid by Personal Check______Chapter Check______Cash__________
Revised 3/2007