T-SHIRT
ORDER FORM |
| YOUR SHIPPING ADDRESS | |
| Your Name | |
| Street Address | |
| City | |
| State/Province | |
| Zip Code/Postal Code | |
| Country | |
| Email Address | |
| ORDER FORM | |||
| Description | Price |
Quantity |
Item
Total |
| Medium - Robot Skull T-Shirt, Black Shirt with White Logo on Front | $9 |
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| Large - Robot Skull T-Shirt, Black Shirt with White Logo on Front | $9 |
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| Extra Large - Robot Skull T-Shirt, Black Shirt with White Logo on Front | $9 |
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Subtotal |
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California
Residents Only, California sales tax 8.25% |
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Shipping
& Handling: US/Canada $3 per shirt International $6 per shirt |
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Total
$US |
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Print
This Form and Send with Payment to: Check
or Money Order Payable to "IMPACTCO" |
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