Please print or write clearly.  Include phone and email address in case of questions.
 
 

Name:___________________________________________________________________

Mailing Address:___________________________________________________________

________________________________________________________________________
 

Phone #: __________________________   E-Mail: _______________________________
 
 

Item	Quantity	Price	Subtotal
Blue Cap:	________	x  $10	=   $____________
Blue T-shirt:	_________	x  $15	=   $____________
T-shirt is only available in XXL
Shipping & Handling ($5.00 for either a hat or a shirt, $6.00 if ordering one of each)			=   $____________
Total of Order			=   $____________

Payment enclosed:  ______________  Check #___________  Money Order ___________

Please fill out the form and mail with your check or money order to:

Orlin Hanson
PO Box 28
Sherwood ND 58782