Repoman.com - T-Shirt Order Form
Pay by Credit Card Option
Print, prepare and fax this to: 803-396-0722
 

Name:__________________________________________________________________________________    

Mailing Address:__________________________________________________________________________

City, State, Zip:____________________________________________________________________________
                                                                    

 Office Phone:____________________________________

E-mail Address:____________________________________________________________________________

Credit Card Info

Circle one: VISA or MasterCard ONLY

Card Holder Name:_________________________________________________________________________

Card Holder Address:_______________________________________________________________________

City, State, Zip:_____________________________________________________________________________

Card Number:______________________________________________________________________________

Expiration Date:____________________________________________________________________________

Cost of each shirt: $12.00
Shipping: $5 for one shirt.
plus $1 shipping per additional shirt.
Amount authorized to charge on card: $_________   

Number of shirts:  (Large ____) - (XL ____) - (XXL _____)

May also be mailed with a check to:

Repoman.com - USAWeb.com
P.O. Box 455     Ft. Mill, SC  29716
Email questions: johnj@usaweb.com (Pay Pal Address)