SUBMARINE PATCH (SUBMUG) ORDER FORM
Orders shipped to other than USPS Zip Coded addresses will be billed actual USPS shipping costs. |
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| PATCH # OR PERSONALIZATION | PATCH # OR PERSONALIZATION |
| Line 1: ________________________ | Line 1: ________________________ |
| Line 2: ________________________ | Line 2: ________________________ |
| Line 3: ________________________ | Line 3: ________________________ |
| CREDIT CARD BILLING ADDRESS: | MERCHANDISE SHIP TO ADDRESS: (IF DIFFERENT) |
| Name: ___________________________________ | Name: _____________________________________ |
| Address: _________________________________ | Address: ___________________________________ |
| City: _____________________________________ | City: ______________________________________ |
| State: ______ ZIP: _________-________ | State: ______ ZIP: _________-________ |
| Contact Name: _____________________________ | Daytime Phone #: _____________________________ |
| Email: ____________________________________ | Fax #: ______________________________________ |
| SUBMUGS $19.95 EACH - VIRGINIA RESIDENTS ADD 5% SALES TAX |
| Credit Card #:_______________________________________________ Exp. Date: ___________________ |
| Credit Card 3/4 Digit Security Code: ____________________ |
| Card Holder's Name As Imprinted On Card (PRINT): _____________________________________________ |
| Card Holder's Signature: __________________________________________________________________ |
| (Unsigned credit card orders or orders without the credit card security code WILL NOT Be Processed) |