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| Basic
Vest, Pocket and Button Front S -
XL / 2XL / 3XL |
$24.00 / $27.00 / $30.00
|
| Embroidered
Silver or Gold Dolphins on Left Front Above Name (If applicable) |
N/C |
| Large USSVI Logo Patch Sent Separately / Affixed To Back |
$11.00 / $16.00
|
| USSVI Logo Patch Direct Embroidered On Back |
$20.00
|
| First Name Personalization On Left Front Chest |
$8.00
|
| Print First Name: | |
| Lettering Direct Embroidered Above Patch On Back $0.50 per Letter | |
| Print Lettering Here: | Total: |
| Lettering Direct Embroidered Below Patch On Back $0.50 per Letter | |
| Print Lettering Here: | Total: |
| Boat Names & Hull Numbers
Embroidered On Back $0.50 per
Letter As Below |
|
| First Boat: | Total: |
| Second Boat: | Total: |
| Third Boat: | Total: |
| Fourth Boat: | Total: |
| Fifth Boat: | Total: |
| Sixth Boat: | Total: |
| Use additional sheet if necessary for additional boat names | |
|
Sub Total
|
|
| VA Sales Tax 5% (If Shipped To VA) |
|
| Grand Total | |
| 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
#:
________________________________________ |
| IF ORDERING PATCHES AND PAYING BY CHECK
OR M.O., MAKE SURE TO INCLUDE
THE S&H FOR PATCHES OR
THEY WILL NOT BE SHIPPED! |
| 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)
|