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: |
SHIP TO ADDRESS: (IF DIFFERENT) |
| Name:
|
Name:
|
| Address:
|
Address: |
| City:
|
City:
|
| State:
ZIP: |
State:
ZIP: |
| Contact
Name: |
Contact's
Daytime
Phone #: |
| Email:
|
Contact's
Fax
#: |
| 11 OZ.
SUBMUGS $15.95 + $5.95
S&H -
FLORIDA RESIDENTS
ADD 7% 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)
|