Name:  _______________________________________________________

Address: ______________________________________________________

State: _______________________________ Zip Code: ________________

Day Phone: (____)________________ Night Phone: (____)_____________

Email Address: _________________________________________________

Shipping Name and Address (if different from above):

______________________________________________________________

______________________________________________________________

______________________________________________________________


SHORT S    LONG S        QTY        COLOR       SIZE         PRICE      TOTAL

_______    _______    _______    _______    _______    _______   _______
 
_______    _______    _______    _______    _______    _______   _______
 
_______    _______    _______    _______    _______    _______   _______
 
_______    _______    _______    _______    _______    _______   _______

                                                                            SUBTOTAL   $ _______

                                                SHIPPING ($5.00 PER ITEM)  $_______

                                                                      GRAND TOTAL   $_______