Please Print & Fill Out Form and Return with Check / Money Order to the Following Address:
Tommy Elston Racing
824 Johnson Street
Keokuk, IA 52632
| NAME:(Please Print)______________________________________________________________ |
| ADDRESS:______________________________________________________________________ |
| CITY:________________________________________STATE_________ZIP:_______________ |
| DAYTIME PHONE:________________________EVENING PHONE______________________ |
| EMAIL ADDRESS:_______________________________________________________________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| White Tommy Elston T-Shirts | |||
Size Small |
$12.00 | __________ | __________ |
Size Medium |
$12.00 | __________ | __________ |
Size Large |
$12.00 | __________ | __________ |
Size XL |
$15.00 | __________ | __________ |
Size 2XL |
$15.00 | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| White Tommy Elston Sweatshirts | |||
Size Medium |
$20.00 | __________ | __________ |
Size Large |
$20.00 | __________ | __________ |
| Please Add $5.00 S&H to your Amount Totals | $5.00 |
| Please Add all Total Amounts + Shipping & Handling | __________ |