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

Andy's Frozen Custard
c/o Kate Bauer 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 2012 Late Model / Modified T-Shirt

DESCRIPTION PRICE BLACK QTY TOTAL
Terry Phillips 2012 Late Model / Modified T-Shirt
Size Adult Small
 $20.00 __________ __________
Size Adult Medium
 $20.00 __________ __________
Size Adult Large
 $20.00 __________ __________
Size Adult XL
 $20.00 __________ __________
Size Adult 2XL
 $20.00 __________ __________
Size Adult 3XL
 $20.00 __________ __________

Item #2 :: Terry Phillips Racing 2011 Team T-Shirt

DESCRIPTION PRICE WHITE QTY GRAY QTY YELLOW QTY TOTAL
Terry Phillips Racing 2011 Team 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 #3 :: Terry Phillips 2011 Race T-Shirt

DESCRIPTION PRICE WHITE QTY BLACK QTY TOTAL
Terry Phillips 2011 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 #4 :: Jeremy Payne 2010 Race T-Shirt

DESCRIPTION PRICE WHITE QTY BLACK 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 '10 LM 1:24 Scale (Item #5)
 $51.00 __________ __________
JP '10 LM 1:24 Scale (Item #6)
 $51.00 __________ __________
TP '10 Mod 1:24 Scale (Item #7)
 $49.00 __________ __________
TP '10 Mod 1:64 Scale (Item #7)
 $15.00 __________ __________
JP '10 Mod 1:24 Scale (Item #8)
 $49.00 __________ __________
JP '10 Mod 1:64 Scale (Item #8)
 $15.00 __________ __________
TP '09 LM 1:24 Scale (Item #9)
 $38.00 __________ __________
JP '09 LM 1:24 Scale (Item #10)
 $38.00 __________ __________
TP #75 Black Beanie (Item #11)
 $10.00 __________ __________
JP #74 Black Beanie (Item #12)
 $10.00 __________ __________
TP #75 Black Twill Cap (Item #13)
 $12.00 __________ __________
TP #75 Khaki Twill Cap (Item #14)
 $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!!!