T-Shirt Mail Order Form - from the Chincoteague Natural History Association
Instructions:
  1. Print out this form
  2. Fill in the information
  3. Determine the total cost of the items
  4. Add shipping & handling
  5. Virginia residents add  4.5 % sales tax
  6. Calculate total
 Mail to:

Chincoteague Natural History Association
P.O. Box 917
Chincoteague, VA 23336

Checks, Money Orders, Master Card & Visa Accepted
Youth Sizes:
Medium or Large - $10.95
in White, Natural, Yellow, or Light Blue 		Adult Sizes:
Medium, Large, XLarge - $13.95
XXLarge - $14.95
in White, Natural, Yellow, Stonewash Green, Light Oxford (a gray tone), and Sandstone
Item Size
for example:
Youth-Medium		 Color
see above		 Quantity Price Each
see above		 Subtotals
Piping Plover Design T-Shirt          
Piping Plover Design T-Shirt          
Subtotal for all Shirts  
Virginia Sales Tax - Virginia Residents Only (4.5 percent of Subtotal for all Shirts)  
Shipping & Handling (Continental U.S.) based on Subtotal for all Shirts:
$00.00 - $20.00 -- $4.95
$20.01 - $35.00 -- $5.95
$35.01 - $50.00 -- $6.95
over $50.00 -- call for charges		  
Grand Total  
Credit Card Information
____ Visa
____ Master Card		 ____ Check or Money Order Enclosed
Name as it appears on the card ____________________________

Credit Card Number ____________________________________

Expiration Date (Month/Year) ________________

Signature _________________________________

Billing Address

Name

Apt. Number

Street Address

City

State & Zip

Telephone

Email

Ship to (leave blank if same as billing address):

Name

Apt. Number

Street Address

City

State & Zip

Telephone

Email