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
| NAME:(Please Print)______________________________________________________________ |
| ADDRESS:______________________________________________________________________ |
| CITY:________________________________________STATE_________ZIP:_______________ |
| DAYTIME PHONE:________________________EVENING PHONE______________________ |
| EMAIL ADDRESS:_______________________________________________________________ |
| 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 | __________ | __________ | __________ |
| 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 | __________ | __________ | __________ |
| 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 | __________ | __________ |
| Please Add $5.00 S&H to your Amount Totals |
$5.00 |
| Please Add all Total Amounts + Shipping & Handling | __________ |