HOLY NAME JACKET ORDER FORM

Name:

Street Address:

City, State, Zip:

Phone Number:

E-Mail address:

Number of Jackets @75.00 each __________   total: _____________

Size(s): S   M   L   XL   XXL   XXXL ____________________________

(not available in long)

Shipping/handling:                                                         total: $15.00

(flat rate, any domestic address)                                     (Per jacket)

Cadet name option:                                                       total: $ 5.00

                                                                                    (Per jacket)

name as you want it to appear on jacket________________________

years marched____________________________________________________

                                                                                    Total Payment:______

check_______________

money order_____

If you wish it shipped to an address other than the address shown above:

(Note: overnight shipping is not available)

name:_______________________________________________________________

street address:_____________________________________________________

city, state,

zip:______________________________________________________

phone number:_______________________________________________________

I prefer to pick up my jacket personally:____