Please Print & Fill Out Form and Return with Check / Money Order to the Following Address:

Andy's Frozen Custard
c/o Todd Arth Web Apparel
440 S. Campbell Ave.
Springfield, MO 65806

Please Allow 2-3 Weeks Delivery Time (Depending on Race Schedule & Availability)
Please Make Checks Payable to Andy's Frozen Custard & Do Not Forget Shipping & Handling!
NAME:(Please Print)______________________________________________________________
ADDRESS:______________________________________________________________________
CITY:________________________________________STATE_________ZIP:_______________
DAYTIME PHONE:________________________EVENING PHONE______________________
EMAIL ADDRESS:_______________________________________________________________

Item #1 :: Terry Phillips 2010 Race T-Shirt

DESCRIPTION PRICE WHITE QTY GRAY QTY TOTAL
Terry Phillips 2010 Race T-Shirt        
Size Youth Large
 $20.00 __________ __________ __________
Size Adult Small
 $20.00 __________ __________ __________
Size Adult Medium
 $20.00 __________ __________ __________
Size Adult Large
 $20.00 __________ __________ __________
Size Adult XL
 $20.00 __________ __________ __________
Size Adult 2XL
 $22.00 __________ __________ __________
Size Adult 3XL
 $22.00 __________ __________ __________
Size Adult 4XL
 $22.00 __________ __________ __________

Item #2 :: Jeremy Payne 2010 Race T-Shirt

DESCRIPTION PRICE WHITE QTY GRAY QTY TOTAL
Jeremy Payne 2010 Race T-Shirt        
Size Youth Large
 $20.00 __________ __________ __________
Size Adult Small
 $20.00 __________ __________ __________
Size Adult Medium
 $20.00 __________ __________ __________
Size Adult Large
 $20.00 __________ __________ __________
Size Adult XL
 $20.00 __________ __________ __________
Size Adult 2XL
 $22.00 __________ __________ __________
Size Adult 3XL
 $22.00 __________ __________ __________
Size Adult 4XL
 $22.00 __________ __________ __________

Hats & Merchandise

DESCRIPTION PRICE QUANTITY TOTAL
Misc. Hats & Merchandise      
TP '09 Diecast Car (Item #3)
 $38.00 __________ __________
JP '09 Diecast Car (Item #4)
 $38.00 __________ __________
TP #75 Black Beanie (Item #5)
 $10.00 __________ __________
JP #74 Black Beanie (Item #6)
 $10.00 __________ __________
TP #75 Black Twill Cap (Item #7)
 $12.00 __________ __________
TP #75 Khaki Twill Cap (Item #8)
 $12.00 __________ __________

Shipping & Handling

Please Add $5.00 S&H to your Amount Totals
$5.00

Grand Total

Please Add all Total Amounts + Shipping & Handling __________
TERRY PHILLIPS RACING IS NOT RESPONSIBLE FOR LOST ORDERS OR MERCHANDISE. PLEASE SEND ONLY CHECKS OR MONEY ORDERS WITH YOUR PRINTED ORDER FORM. THANK YOU FOR YOUR SUPPORT OF TERRY PHILLIPS RACING!!!