QUICKSILVER T-SHIRT ORDER FORM
 
NAME
ADDRESS
 (NO PO BOXES)
CITY
STATE
ZIP
EMAIL
PHONE
QUICKSILVER OR SYSTEM T-SHIRT: (PLEASE CIRCLE CHOICE)
QTY SMALL @ $14.95 QUICKSILVER / SYSTEM
  MEDIUM @ $14.95 QUICKSILVER / SYSTEM
  LARGE @ $14.95 QUICKSILVER / SYSTEM
  X-LARGE @ $14.95 QUICKSILVER / SYSTEM
  2X-LARGE @ $16.95 QUICKSILVER / SYSTEM
  3X-LARGE @ $17.95 QUICKSILVER / SYSTEM
THE CONFUSION T-SHIRT:
QTY SMALL @$15.95
  MEDIUM @$15.95
  LARGE @$15.95
  X-LARGE @$15.95
  2X-LARGE @17.95
  3X-LARGE @18.95
 
SUBTOTAL
7% SALES TAX (IA RESIDENTS ONLY)
SHIPPING & HANDLING
$5.00
  
 
TOTAL
PAYMENT METHOD:
VISA / MASTERCARD
CARD #
CHECK
EXP

MAKE CHECKS PAYABLE TO A&R MARKETING. COMPLETE FORM AND MAIL
WITH CHECK OR CREDIT CARD INFO TO:

A&R MARKETING
QUICKSILVER T-SHIRT OFFER
108 HAYWARD AVENUE
SUITE 201
AMES IA 50014

YOU MAY ALSO FAX COMPLETED FORMS WITH CREDIT CARD INFO TO:
(515) 296-4654. FOR QUESTIONS, .