| Customer E-Mail |
Important: Enter a valid e-mail address. Receipts will be sent to this address. |
| *E-Mail: | | |
| T-Shirt Selection |
| Description | Selection | Qty | Total |
| T-Shirt 1: |
| |
|
| *Color: | Black White Blue Red |
| T-Shirt 2: |
| |
|
| *Color: | Black White Blue Red |
| Polo-Shirt: |
| |
|
| *Color: | Black White Blue Red |
| Sweat-Shirt: |
| |
|
| *Color: | Black White Blue Red |
| Sub-Total: | | |
| Shipping & Handling: |
| |
| Grand Total: | | |
| Billing Information |
| *First Name: | | Same name as on your card |
| Middle Initial: | | |
| *Last Name: | | |
| *Address Line 1: | | |
| Address Line 2: | | Apt. or Suite No. |
| *City: | | |
| *Province: | | |
| *Postal Code: | | |
| Phone: | | |
| Shipping Information |
| *Same as billing info | Yes No |
| *First Name: | | |
| Middle Initial: | | |
| *Last Name: | | |
| *Address Line 1: | | |
| Address Line 2: | | |
| *City: | | |
| *Province: | | |
| *Postal Code: | | |
| Payment Information |
| *Payment Type | Credit Card Cash on Delivery (C.O.D.) |
| *Card Number: | | No dashes or spaces please |
| *Expiration Month: | | From your card |
| *Expiration Year: | | From your card |
| *Card Brand: |
| |
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