Send me a Hope for Healing T-Shirt
(print this page, fill it out and mail it in)
Name: ___________________________________________
Address: _________________________________________
City: ____________________________________________
State: ___________________________________________
Zip: _____________________________________________
Phone number: ____________________________________
Email Address: _____________________________________
Please write in the quantity of each size you'd like to order:
____ small
____ medium
____ large
____ XLarge
____ 2XLarge
____ 3XLarge
____ 4XLarge
Total number of shirts: ________
Total Amount ($20/shirt) _______
I'll pay for my t-shirt by:
____ Check or money order (Payable to FORGE)
____ Credit Card
Name on card: ________________________________
Card number: _________________________________
Expiration date: _______________________________
3 digit code on back:___________________________
Signature:____________________________________ |
Mail this form to FORGE, PO Box 1272, Milwaukee, WI 53201 |
