Mail  this form to:

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Dixie Rogerson-Bill
Gordon Bill
367-B Summers Road
Centralia, WA 98531
(360) 736-5584 (Phone)
Email: dixie@localaccess.com
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MAILING INFORMATION:

Name (First and Last) ___________________________________________

Address: ___________________________________________


City: _________________________ State: _______ Zip:____________

Phone:______________________  Fax:________________________

E-Mail Address:_____________________________________________


PAYMENT...sorry we have no credit card service

ORDER INFORMATION
(Shipping and Handling charges will be added):
Washington state tax

PRODUCT                 COUNT        SIZE (shirts)    ART TITLE/PRICE                               


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Thank you for your order!