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ORDER FORM  (all prices in U.S. curency)

Circle Size

Elephant or Zebra

Circle Color
 
#_____Men's short sleeve Besse Art SAFARI SHIRT @ $55 per shirt

M   L   XL   XXL

         Z

Safari   Gray
 $______
#_____Men's long sleeve Besse Art SAFARI SHIRT @ $60 per shirt

M   L   XL   XXL

         Z

Safari   Gray
 $______
#_____Women's short sleeve Besse Art SAFARI SHIRT @ $50 per shirt

XS  S  M   L   XL

         Z

Safari  White
 $______
#_____Women's long sleeve Besse Art SAFARI SHIRT @ $55 per shirt

XS  S  M   L   XL

         Z

Safari  White
 $______

Note: 

Sizes run large      
     

Subtotal
 $______

Send check to:

Linda Besse
15908 E. Cooper Rd.
Mead, WA 99021

Domestic Handling & Shipping $5.00 for 1 shirt + $2.50 ea. addt'l shirt

WA state sales tax (applicable for instate sales) 8.1%

TOTAL

 $______
 $______
 $______

OR       Payment Information       VISA       MasterCard       Discover       (Circle one)

Card # _______________________ Exp. Date ________ Cardholder's Name: ___________________________

Signature: ____________________________________ Amount $ __________

 SHIP TO:



 


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