vmaxclub.jpg (12574 bytes)

 order form  vmaxclub3com.jpg (3139 bytes)

Please complete, print, and send this form to me, with your check or money order (address below)  

item Quantity colorcode sizecode price each item total
example: shirt 2 BTS XLG 12.00 24.00
  sub total
shipping
TOTAL

shipping is $3.00 first item, $1.00 ea additional item

*Name  *Mem #
*Street    PO Box 
*City     *State *Zip code

TEL: *Day ()- *Eve ()- Fax ()-
*Email address (uraddress@urprov.com)

Please complete the form, print it out and mail the completed form to the address listed below, along with a check for the total amount.Please make check payable to "Darren Gist."

OR...

I Now Accept "Pay Pal"!!

E-mail Me.                       

 

Darren Gist
115 SW Tunison Street
Corvallis, OR  97333