$12.95 |
Name ___________________ | Address _____________________________ | Telephone (___)___________ |
City, State __________,_____ | Zip Code _____________________________ | Country _______________ |
1 T-Shirt S_ M_ L_ XL_ | X $12.95 = | $12.95 |
Shipping and Handling | $6 US, $7 Int'l | $___________ |
Your total is | $___________ |