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Your name________________________________________________________
Address__________________________________________________________
_________________________________________________________________
___________________________________________________________________
Telephone Number________________e-mail address:_____________________
| Item number | Size | Item Description | Price Each | Quantity | Line Total |
|
International Shipping
|
$20 | --------- |
$20
|
||
| Total---> |
| Please enclose a certified check or money order in U.S. funds, or enter credit card information below:
Card type (check one)_____Visa ______MasterCard ______American Express ________Discover Card number_________________________________ Expiration date________________________________ Name on card_________________________________ Signature____________________________________ Card billing address (if different from address above) ____________________________________________ ____________________________________________ |
Mail completed form to: Dynasty Soccer Gear If you are using a credit card (Visa , MC, AmEx, Discover), you may fax this form to: (919) 469-2278 You order will be shipped upon receipt of funds. You may contact us by calling or e-mail Thank you for visiting www.dynastysoccergear.com |